Southern Valley Psychology Clinic, PA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

SOUTHERN VALLEY PSYCHOLOGY CLINIC, PA

Practice address

11 Civic Center PLZ
Ste 201
Mankato, MN 56001-7710

Phone

(507) 385-7725

Fax

(507) 385-0576

NPI assigned

Feb 18, 2007

Organization subpart

No

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

Authorized official

Name

Barbara Glass, PSY.D..,L.P.

Title

Partner

Phone

(507) 385-7725

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacquelyn Marie Jauss, PH.D.,L.P.

  • Clinical Psychologist
  • Amboy, MN
  • NPI 1235273624
  Medicare reassignment
• Adam Anderson, PHD

  • Clinical Psychologist
  • Mankato, MN
  • NPI 1467569962
  NPD (past)

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

{
    "created_epoch": "1171756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359936000000",
    "number": "1407990807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CIVIC CENTER PLZ",
            "address_2": "STE 201",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017710",
            "telephone_number": "507-385-7725",
            "fax_number": "507-385-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 CIVIC CENTER PLZ",
            "address_2": "STE 201",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017710",
            "telephone_number": "507-385-7725",
            "fax_number": "507-385-0576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN VALLEY PSYCHOLOGY CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-18",
        "last_updated": "2013-02-04",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "507-385-7725",
        "authorized_official_credential": "PSY.D..,L.P."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "318G1SO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "241913100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "1383",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Debra Diane Sowers, RN, NP
• Joshua Aaron Lee Spear, MD
• Martha Speckel, CCC-SLP
• Marissa Ann Spencer, PA
• Deneal Marie Sperle, LPC

• Professional Counselor in Mankato, MN
• Providers in Mankato, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.