Gary P Liaboe, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP 0737 Issued in MN

Practice address

3820 Cleveland Ave N
# 400
Arden Hills, MN 55112-3285

Phone

(651) 389-4400

Fax

(651) 389-4410

NPI assigned

Sep 20, 2006

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

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gary P. Liaboe, PHD, LP, LLC

  • Psychologist
  • Arden Hills, MN
  • NPI 1164610598
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184722530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3820 CLEVELAND AVE N",
            "address_2": "# 400",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551123285",
            "telephone_number": "651-389-4400",
            "fax_number": "651-389-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3820 CLEVELAND AVE N",
            "address_2": "# 400",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551123285",
            "telephone_number": "651-389-4400",
            "fax_number": "651-389-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIABOE",
        "first_name": "GARY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP 0737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "191366",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WAUSAU",
            "identifier": "80174310",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC LIFE",
            "identifier": "232253",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHARIORAL HEALTH",
            "identifier": "6142913",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0005947146",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PATIENT CHOICE",
            "identifier": "8017430",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "97095547005",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD",
            "identifier": "324L6CO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kalina Maina Lee
• Katalina Lee
• Susan Lee
• Stephanie Lewis
• Huilin Li
• Lieia Yanyan Liang, RN
• Jenny E. S. Lief, M.A., CCC SLP
• Anna Mae Larson Lindgren
• Ashley M Lindgren
• Timothy Lively

• Clinical Psychologist in Arden Hills, MN
• Providers in Arden Hills, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.