Elizabeth Anne Heidenreich, PSY.D. LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

GL0077 Issued in MN

Practice address

5200 Willson Road
Suite 150
Edina, MN 55424

Phone

(612) 208-8087

Fax

(651) 628-0411

NPI assigned

Oct 11, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 20, 2024 through May 20, 2028

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.

• Family Support Services Inc.

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD

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

{
    "created_epoch": "1349913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1124370358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 WILLSON ROAD",
            "address_2": "SUITE 150",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55424",
            "telephone_number": "612-208-8087",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 WILLSON ROAD",
            "address_2": "SUITE 150",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55424",
            "telephone_number": "612-208-8087",
            "fax_number": "651-628-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIDENREICH",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PSY.D. LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-11",
        "last_updated": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "DC",
            "license": "PSY1000836",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "GL0077",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "05232",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Hecht, PH.D., L.P.
• Levi Robert Hedine, CMT
• Shruti Ulhas Hegde, PA-C
• Kari Ann Hegg, PA
• Heide'S Mastectomy Services, Inc.
• Heidi M Brandenburg DDS PA
• Marguerite Y Heie, P.T.
• Steven Heifetz, M.D.
• Christie Sue Heikes, MD
• Jonathan Heimdal, DPT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.