Active NPI
Del Sand
- Psychologist
- Lake Elmo, MN
National Provider Identifier
1447410121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP0701
- Practice address
- 3819 Laverne Ave N
Lake Elmo, MN 55042-9629 - Phone
- (651) 770-2224
- NPI assigned
- Jun 16, 2008
- Last updated
- Jun 16, 2008
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP0701 | MN | Primary |
Addresses
Primary practice location
3819 Laverne Ave N
Lake Elmo, MN 55042-9629
Mailing address
1096 E 260TH St
New Prague, MN 56071-8880
Phone (320) 255-9530
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 |
|---|---|---|---|
| LP0701 | MN | MD | Addiction (Substance Use Disorder) Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacy 2, LLC | Past | Accepting new patients | |
| Thrive Behavioral Network III, LLC | Past | Accepting new patients | |
| Thrive Behavioral Network III, LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Lake Elmo, MN
- NPI 1184840639
-
dba Willow Haven
- Mental Illness Community Based Residential Treatment Facility
- Lake Elmo, MN
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213574400000",
"number": "1447410121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1096 E 260TH ST",
"city": "NEW PRAGUE",
"state": "MN",
"postal_code": "560718880",
"telephone_number": "320-255-9530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3819 LAVERNE AVE N",
"city": "LAKE ELMO",
"state": "MN",
"postal_code": "550429629",
"telephone_number": "651-770-2224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAND",
"first_name": "DEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-16",
"last_updated": "2008-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP0701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Elmo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.