Stephanie Rae Forness, PSYD, LP

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

LP-4345 Issued in MN

Practice address

1212 E College Dr
Marshall, MN 56258-2010

Phone

(507) 532-3236

Fax

(507) 532-0240

NPI assigned

Aug 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Ms. Stephanie Rae Faber Former name

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, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Canvas Health IncGroup PAC ID 8729073978, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Canvas Health, Inc.

  • Mental Health Counselor
  • Oakdale, MN
  • NPI 1922051325
  Medicare reassignment Care Compare group NPD
• Canvas Health, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Forest Lake, MN
  • NPI 1528129574
  NPD (past)

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275545527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 S WHITNEY ST",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562581932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 E COLLEGE DR",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562582010",
            "telephone_number": "507-532-3236",
            "fax_number": "507-532-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNESS",
        "first_name": "STEPHANIE",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP-4345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIOUX VALLEY HEALTH",
            "identifier": "41552",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1043064",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "136319",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "948S3FO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP49480",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "FABER",
            "middle_name": "RAE",
            "prefix": "MS.",
            "credential": "MA, LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Thomas Fischer
• Lee Fixen, D.C.
• Quentin James Fixen, D.C.
• Erin Marie Flann, P.T.
• Joyce Ella Flock
• Andrew Frerich, D.D.S.
• John W Frerich, DDS
• Theodore L. Fritsche, M.D.
• Jodi Marie Fuerstenberg, ATC
• Amy Jo Full, DDS

• Counseling Psychologist in Marshall, MN
• Providers in Marshall, MN by specialty
• Counseling 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.