Active NPI
Mary Vanderloop
- Psychologist
- St Louis Park, MN
National Provider Identifier
1083690606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP3936
- Practice address
- 6490 Excelsior Blvd
# E315
St Louis Park, MN 55426-4705 - Phone
- (952) 993-6200
- NPI assigned
- Dec 15, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP3936 | MN | Primary |
Addresses
Primary practice location
6490 Excelsior Blvd
# E315
St Louis Park, MN 55426-4705
Mailing address
6465 Wayzata Blvd
Suite 315
Minneapolis, MN 55426-1728
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1995
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
621 W Lake St
Suite 350
Minneapolis, MN 55408-2952
Phone (612) 979-2276
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP3936 | MN | MD | Psychologist |
| 3936 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lyn-Lake Psychotherapy and Wellness LTD. | Current | Accepting new patients |
Locations
2900 Thomas Ave S
Ste 100
Minneapolis, MN 55416
621 W Lake St
Ste 350
Minneapolis, MN 55408
Phone (612) 547-9990
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Minneapolis, MN
- NPI 1609355163
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1083690606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6465 WAYZATA BLVD",
"address_2": "SUITE 315",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554261728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6490 EXCELSIOR BLVD",
"address_2": "# E315",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554264705",
"telephone_number": "952-993-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERLOOP",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-15",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP3936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.