Active NPI
Thomas Wright Bursack, M.A.L.P.
- Psychologist
- St Louis Park, MN
National Provider Identifier
1144503822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP3770
- Practice address
- 7515 Wayzata Blvd
Suite 210
St Louis Park, MN 55426-1604 - Phone
- (763) 568-1773
- NPI assigned
- Sep 20, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP3770 | MN | Primary |
Addresses
Primary practice location
7515 Wayzata Blvd
Suite 210
St Louis Park, MN 55426-1604
Mailing address
7515 Wayzata Blvd
Suite 210
St. Louis Park, MN 55426
Phone (763) 568-1773
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP3770 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316476800000",
"number": "1144503822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7515 WAYZATA BLVD",
"address_2": "SUITE 210",
"city": "ST. LOUIS PARK",
"state": "MN",
"postal_code": "55426",
"telephone_number": "763-568-1773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7515 WAYZATA BLVD",
"address_2": "SUITE 210",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554261604",
"telephone_number": "763-568-1773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURSACK",
"first_name": "THOMAS",
"middle_name": "WRIGHT",
"name_prefix": "Mr.",
"credential": "M.A.L.P.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-20",
"last_updated": "2011-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP3770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.