Philip Psychological Clinic

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP2258 Issued in MN

Legal business name

PHILIP PSYCHOLOGICAL CLINIC

Practice address

510 Sibley Street
Suite 200
Mankato, MN 56001

Phone

(207) 345-5049

Fax

(507) 345-5049

NPI assigned

Feb 14, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Ponvelil Philipose Philip, PHD CLINICAL PSYCH

Title

Owner Director

Phone

(507) 345-5049

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1326216169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 SIBLEY STREET",
            "address_2": "SUITE 200",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "207-345-5049",
            "fax_number": "507-345-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 SIBLEY STREET",
            "address_2": "SUITE 200",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "207-345-5049",
            "fax_number": "507-345-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP PSYCHOLOGICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "PHILIP",
        "authorized_official_first_name": "PONVELIL",
        "authorized_official_middle_name": "PHILIPOSE",
        "authorized_official_title_or_position": "OWNER DIRECTOR",
        "authorized_official_telephone_number": "507-345-5049",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD CLINICAL PSYCH"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP2258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "41516PH",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven P Peterson, MS, LP
• Allison Petzel, DPT
• Lindsey Kristine Smits Pfarr, OTR/L
• Taylor Marie Pfeifer
• Tri Quoc Pham, DO, MA
• Catherine Marie Phillips, PA-C
• Connie Ellis Phillips, PT
• Danielle Phillips
• Lisa Kay Phillips
• Phoenix Group Homes, Inc.

• Clinical Psychologist in Mankato, MN
• Providers in Mankato, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; 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.