Woodcrest Counseling, Inc

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3334 Issued in MN

Legal business name

WOODCREST COUNSELING, INC

Practice address

521 Tanglewood Dr
Shoreview, MN 55126-2016

Phone

(763) 753-1785

Fax

(763) 753-1753

NPI assigned

Jul 8, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Thomas Michael Graske, M.A., L.P.

Title

Psychologist / Owner

Phone

(763) 753-1785

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Thomas M Graske, M.A., L.P. Doing business as

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144228776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 TANGLEWOOD DR",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551262016",
            "telephone_number": "763-753-1785",
            "fax_number": "763-753-1753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 TANGLEWOOD DR",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551262016",
            "telephone_number": "763-753-1785",
            "fax_number": "763-753-1753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODCREST COUNSELING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRASKE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PSYCHOLOGIST / OWNER",
        "authorized_official_telephone_number": "763-753-1785",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A., L.P."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BOARD OF PSYCHOLOGY",
            "identifier": "LP3334",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thomas M Graske, M.A., L.P.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.