NPIMap

Organization Active NPI

Advanced Psychological Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mankato, MN
National Provider Identifier
1053066902
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
ADVANCED PSYCHOLOGICAL SERVICES, LLC
Practice address
304 Belle Ave
Mankato, MN 56001-5250
Phone
(877) 909-5511
Fax
(507) 888-0001
NPI assigned
Feb 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kesha Fettig
Title
Clinic Coordinator
Phone
(507) 735-6449

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

304 Belle Ave
Mankato, MN 56001-5250

Mailing address

304 Belle Ave
Mankato, MN 56001-5250
Phone (877) 909-5511

Other names 2

  • Advanced Psychological Services, LLC Doing business as
  • Timothy Benesch Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240321002684 MN Part B Supplier - Clinic/Group Practice 8729425087 Receives reassigned benefits from 1 practitioner
Practice locations: Mankato, MN

National Provider Directory

National Provider Directory

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1053066902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 BELLE AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015250",
            "telephone_number": "877-909-5511",
            "fax_number": "507-888-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 BELLE AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015250",
            "telephone_number": "877-909-5511",
            "fax_number": "507-888-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-18",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "FETTIG",
        "authorized_official_first_name": "KESHA",
        "authorized_official_title_or_position": "CLINIC COORDINATOR",
        "authorized_official_telephone_number": "507-735-6449"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Psychological Services, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Psychological Services, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Timothy Benesch",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.