Tim Scott Herzog

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

Practice address

7835 Main St N Ste 220
Maple Grove, MN 55369-7072

Phone

(763) 400-7475

Fax

(763) 400-7473

NPI assigned

Nov 30, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1164026282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4544 3RD ST NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554212149",
            "telephone_number": "651-334-8321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7835 MAIN ST N STE 220",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697072",
            "telephone_number": "763-400-7475",
            "fax_number": "763-400-7473"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5780 Lincoln Dr Ste 250",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554361667",
            "country_code": "US",
            "telephone_number": "763-400-7475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "TIM",
        "middle_name": "SCOTT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-30",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.mn-ccc.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7835 Main St N Ste 220",
            "city": "Maple Grove",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553697072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mark Alan Hermes, PT, DPT
• Trevor Hernandez
• Chad Herrboldt, D.C.
• Rebecca Herrmann, DNP
• Marykay Heruth, PT
• Corey A Hiben, OT
• Deborah Lynn Higgins
• Katherine Higgins
• August F Hiivala, LPCC
• Gregory R Hildebrand, M.D.

• Counseling Psychologist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.