NPIMap

Organization Active NPI

Stone Arch Psychology and Health Services

  • Clinical Psychologist
  • Minneapolis, MN
National Provider Identifier
1124398607
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP3594 Issued in MN
Legal business name
STONE ARCH PSYCHOLOGY AND HEALTH SERVICES
Practice address
219 Main St SE Ste 400
Minneapolis, MN 55414
Phone
(612) 886-2524
Fax
(612) 886-2538
NPI assigned
Dec 30, 2011
Last updated
Jun 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Authorized official

Name
Ms. Susan Gustafson, PSD. LP.NPI 1073686655
Title
Psychologist
Phone
(612) 886-2524

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X LP3594 MN
Adult Development & Aging PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0700X LP3594 MN
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X LP3594 MN
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X LP3594 MN Primary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X LP3594 MN
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X LP3594 MN
School PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TS0200X LP3594 MN

Addresses

Primary practice location

219 Main St SE Ste 400
Minneapolis, MN 55414

Mailing address

219 Main St SE Ste 400
Minneapolis, MN 55414-2151
Phone (612) 886-2524

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120312000071 MN Part B Supplier - Clinic/Group Practice 6709045784 Receives reassigned benefits from 11 practitioners
Practice locations: Minneapolis, MN

National Provider Directory

National Provider Directory

Locations

219 SE Main St
Ste 400
Minneapolis, MN 55414
Phone (612) 886-2524

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1124398607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 MAIN ST SE STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142151",
            "telephone_number": "612-886-2524",
            "fax_number": "612-886-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 MAIN ST SE STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55414",
            "telephone_number": "612-886-2524",
            "fax_number": "612-886-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONE ARCH PSYCHOLOGY AND HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-30",
        "last_updated": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "612-886-2524",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PSD. LP."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3594",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "MN",
            "license": "LP3594",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "LP3594",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3594",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP3594",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP3594",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": "MN",
            "license": "LP3594",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; 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.