Minnesota Family Psychological Services LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3691 Issued in MN

Legal business name

MINNESOTA FAMILY PSYCHOLOGICAL SERVICES LLC

Practice address

7382 Kirkwood CT
Maple Grove, MN 55369-5270

Phone

(763) 424-3704

Fax

(763) 424-8315

NPI assigned

May 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Marcia Rogers, PSY.D.

Title

Owner

Phone

(763) 424-3704

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1180137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386855534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7382 KIRKWOOD CT",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695270",
            "telephone_number": "763-424-3704",
            "fax_number": "763-424-8315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7382 KIRKWOOD CT",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695270",
            "telephone_number": "763-424-3704",
            "fax_number": "763-424-8315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA FAMILY PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-424-3704",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "359G0RO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.