Organization Active NPI

Gambler'S Relief

  • Psychologist
  • Burnsville, MN
National Provider Identifier
1225308786
Registry record updated Dec 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP3228 Issued in MN
Legal business name
GAMBLER'S RELIEF
Practice address
2960 Judicial Rd
210
Burnsville, MN 55337-5507
Phone
(952) 224-2990
Fax
(952) 224-2990
NPI assigned
Dec 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2011

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

Authorized official

Name
Ruth Russo
Title
Business Office Manager
Phone
(952) 224-2990

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 302633 MN
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X LP3228 MN Primary

Addresses

Primary practice location

2960 Judicial Rd
210
Burnsville, MN 55337-5507

Mailing address

2960 Judicial Rd
210
Burnsville, MN 55337-5507
Phone (952) 224-2990

National Provider Directory

National Provider Directory

Locations

2960 Judicial Rd
Ste 210
Burnsville, MN 55337
Phone (952) 224-2990

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325203200000",
    "number": "1225308786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 JUDICIAL RD",
            "address_2": "210",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375507",
            "telephone_number": "952-224-2990",
            "fax_number": "952-224-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 JUDICIAL RD",
            "address_2": "210",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375507",
            "telephone_number": "952-224-2990",
            "fax_number": "952-224-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAMBLER'S RELIEF",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-30",
        "last_updated": "2011-12-30",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "952-224-2990"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302633",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

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

Verify at the official NPI Registry.