Miranda Dyrdahl, PSY.D., LMFT, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP5423 Issued in MN

Practice address

3333 University Ave SE
Minneapolis, MN 55414

Phone

(763) 233-7278

NPI assigned

May 1, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 7

Addresses

Other names 1

• Dr. Miranda Gilmore Former name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Therapeutic Services Agency IncGroup PAC ID 4981877891, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Therapeutic Services Agency Inc

  • Marriage & Family Therapist
  • Pine City, MN
  • NPI 1497741607
  Medicare reassignment Care Compare group NPD
• Fraser Child and Family Center

  • Adolescent and Children Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1609922194

  MN

  Medicare reassignment NPD

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1114148798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 UNIVERSITY AVE SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143325",
            "telephone_number": "763-233-7278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 UNIVERSITY AVE SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55414",
            "telephone_number": "763-233-7278"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2829 Verndale Ave",
            "address_purpose": "LOCATION",
            "city": "Anoka",
            "state": "MN",
            "postal_code": "553031620",
            "country_code": "US",
            "telephone_number": "763-223-7278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DYRDAHL",
        "first_name": "MIRANDA",
        "name_prefix": "Dr.",
        "credential": "PSY.D., LMFT, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "RPS2010006",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "GL0006",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY24149",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2599",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "46860",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "51386",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP5423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "GILMORE",
            "prefix": "DR.",
            "credential": "PSY.D., LMT, LP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sharon Luster Dykes, MD
• Anna Elizabeth Dykhuis, APRN, CNP
• Dennis Dale Dykstra, M.D.
• Tressa G Dykstra, CNP
• Dynamic Health Concepts, Inc.
• Mary Louise Dysart, CNP
• Maurice William Dysken, M.D.
• Randall I Dyson, CRNA
• Laura L Dyste, CRNA
• E & E Home Care Inc

• All providers in Minneapolis, MN
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.