Gary D Vikesland, PHD

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

LP3160 Issued in MN

Practice address

10700 Old County Road 15 Ste 170
Plymouth, MN 55441-8709

Phone

(763) 525-8590

Fax

(763) 525-8592

NPI assigned

Aug 26, 2005

Last updated

Jan 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2006

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Pathways Psychological Services PAGroup PAC ID 9133161672, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pathways Psychological Services, P.a.

  • Mental Health Counselor
  • Plymouth, MN
  • NPI 1366443723
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1073506846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10700 OLD COUNTY RD 15",
            "address_2": "SUITE 170",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "55441",
            "telephone_number": "763-525-8590",
            "fax_number": "763-525-8592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10700 OLD COUNTY ROAD 15 STE 170",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554418709",
            "telephone_number": "763-525-8590",
            "fax_number": "763-525-8592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIKESLAND",
        "first_name": "GARY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP3160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069523800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Counseling Psychologist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.