The Terrace Group LTD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3094 Issued in MN

Legal business name

THE TERRACE GROUP LTD

Practice address

10580 Wayzata Blvd
Ste 150
Minnetonka, MN 55305-1657

Phone

(952) 595-0562

Fax

(952) 595-0564

NPI assigned

May 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Leland Karl Martin, PHD LPNPI 1003855743

Title

Clinical Director

Phone

(952) 595-0562

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

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

• Leland Karl Martin, PHD

  • Clinical Psychologist
  • Mound, MN
  • NPI 1003855743
  Medicare reassignment NPD Authorized official
• Jennifer Mary Gish, LICSW

  • Clinical Social Worker
  • Minnetonka, MN
  • NPI 1922054949
  NPD (past)
• Jaime Lea Monson, MSW, LICSW

  • Clinical Social Worker
  • New Hope, MN
  • NPI 1538265210
  NPD (past)

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206576000000",
    "number": "1114974201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10580 WAYZATA BLVD",
            "address_2": "STE 150",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051657",
            "telephone_number": "952-595-0562",
            "fax_number": "952-595-0564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10580 WAYZATA BLVD",
            "address_2": "STE 150",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051657",
            "telephone_number": "952-595-0562",
            "fax_number": "952-595-0564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE TERRACE GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2008-03-27",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "LELAND",
        "authorized_official_middle_name": "KARL",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "952-595-0562",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD LP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5H812MA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "C04096",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "50358",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "25G82TE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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.