NPIMap

Organization Active NPI

Maple Grove Counseling Center PA

  • Psychologist
  • Maple Grove, MN
National Provider Identifier
1164496071
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP0951 Issued in MN
Legal business name
MAPLE GROVE COUNSELING CENTER PA
Practice address
13700 83Rd Way
Ste 205
Maple Grove, MN 55369-7015
Phone
(763) 494-8699
Fax
(763) 494-8797
NPI assigned
Feb 15, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Ardith Ann Messicci, MA LPNPI 1447324512
Title
Licensed Psychologist Owner
Phone
(763) 494-8699

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP0951 MN Primary

Addresses

Primary practice location

13700 83Rd Way
Ste 205
Maple Grove, MN 55369-7015

Mailing address

13700 83Rd Way
Ste 205
Maple Grove, MN 55369-7015
Phone (763) 494-8699

Other identifiers 2

IdentifierTypeStateIssuer
88297OtherMNARAZ
3H755MEOtherMNBCBS

National Provider Directory

National Provider Directory

Locations

13700 83rd Way N
Ste 205
Maple Grove, MN 55369
Phone (763) 494-8699

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164496071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13700 83RD WAY",
            "address_2": "STE 205",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697015",
            "telephone_number": "763-494-8699",
            "fax_number": "763-494-8797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13700 83RD WAY",
            "address_2": "STE 205",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697015",
            "telephone_number": "763-494-8699",
            "fax_number": "763-494-8797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE GROVE COUNSELING CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MESSICCI",
        "authorized_official_first_name": "ARDITH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST OWNER",
        "authorized_official_telephone_number": "763-494-8699",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA LP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP0951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "88297",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3H755ME",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • 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.