Thrace A. Soryn, M.A., L.P. – Psychologist

Key facts

NPI: 1366442055
Entity type: Individual (NPI type 1)
Primary specialty: Psychologist 103T00000X
License: LP2562 (MN)
Practice address: 2124 Dupont Ave. So.
Suite G1
MPLS, MN 55405
Phone: (612) 374-2194
NPI assigned: Jul 26, 2005
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Master of Arts

State licenses

License	State	Type	Specialty
LP2562	MN	MD	Psychologist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychologist	103T00000X	LP2562	MN	Yes

Addresses

Primary practice location

2124 Dupont Ave. So.
Suite G1
MPLS, MN 55405

Mailing address

2124 Dupont Ave. So.
Suite G1
MPLS, MN 55405
Phone (612) 374-2194

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 4, 2009.

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233705600000",
    "number": "1366442055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 DUPONT AVE. SO.",
            "address_2": "SUITE G1",
            "city": "MPLS",
            "state": "MN",
            "postal_code": "55405",
            "telephone_number": "612-374-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 DUPONT AVE. SO.",
            "address_2": "SUITE G1",
            "city": "MPLS",
            "state": "MN",
            "postal_code": "55405",
            "telephone_number": "612-374-2194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SORYN",
        "first_name": "THRACE",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "M.A., L.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-26",
        "last_updated": "2009-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP2562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in MPLS, MN

All providers in MPLS, MN · Psychologist in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2009. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.