Marie Lynn Anderson, PSYD, LP, LMFT

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

5635 Issued in MN

Practice address

12760 Aberdeen St NE
Suite 212
Blaine, MN 55449-5845

Phone

(651) 600-2727

Fax

(612) 656-3031

NPI assigned

Oct 6, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1223251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377648000000",
    "number": "1194976407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12760 ABERDEEN ST NE",
            "address_2": "SUITE 212",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554495845",
            "telephone_number": "651-600-2727",
            "fax_number": "612-656-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12760 ABERDEEN ST NE",
            "address_2": "SUITE 212",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554495845",
            "telephone_number": "651-600-2727",
            "fax_number": "612-656-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARIE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP, LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-06",
        "last_updated": "2013-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "1701",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "5635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counseling Psychologist in Blaine, MN
• Providers in Blaine, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2013; 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.