Michelle A Brouillette, PHD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP2929 Issued in MN

Practice address

11990 Portland Ave
Burnsville, MN 55337-1516

Phone

(612) 462-7053

Fax

(952) 479-7896

NPI assigned

Dec 28, 2005

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

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, 2006

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Midwest Center for Personal & Family Development PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saint Paul, MN
  • NPI 1285730903
  NPD (past)
• Pathway Virtu-Health

  • Family Nurse Practitioner
  • Shoreview, MN
  • NPI 1073134284
  NPD (past)

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1295712495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11990 PORTLAND AVE",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553371516",
            "telephone_number": "952-435-8814",
            "fax_number": "952-435-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11990 PORTLAND AVE",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553371516",
            "telephone_number": "612-462-7053",
            "fax_number": "952-479-7896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUILLETTE",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-28",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP2929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brightview Therapy Inc
• Brandon Colt Brimer
• Rachael Britton, MA
• Sydney Brock
• Joshua Daniel Brogan, MD
• Emily Kathryn Brovold
• Aaliyah Brown
• Alaina Brown, MATRG, NREMT
• Dori C. Brown, MPT
• Hilary Taylor Brown, MSW, LICSW

• Psychologist in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; 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.