Active NPI
Bradley S Bengtson
- Counseling Psychologist
- Lino Lakes, MN
National Provider Identifier
1417255753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- LP4712
- Practice address
- 33 Village Pkwy
Suite 109
Lino Lakes, MN 55014-4409 - Phone
- (612) 644-2502
- NPI assigned
- Mar 10, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | LP4712 | MN | Primary |
Addresses
Primary practice location
33 Village Pkwy
Suite 109
Lino Lakes, MN 55014-4409
Mailing address
33 Village Pkwy
Suite 109
Lino Lakes, MN 55014-4409
Phone (612) 644-2502
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP4712 | MN | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299715200000",
"number": "1417255753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 VILLAGE PKWY",
"address_2": "SUITE 109",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550144409",
"telephone_number": "612-644-2502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 VILLAGE PKWY",
"address_2": "SUITE 109",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550144409",
"telephone_number": "612-644-2502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENGTSON",
"first_name": "BRADLEY",
"middle_name": "S",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-10",
"last_updated": "2011-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MN",
"license": "LP4712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lino Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.