Central Minnesota Couseling Center, Inc.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Legal business name

CENTRAL MINNESOTA COUSELING CENTER, INC.

Practice address

1500 Northway Dr
Suite 1
Saint Cloud, MN 56303-4477

Phone

(320) 253-4321

Fax

(320) 240-8525

NPI assigned

Aug 21, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Dennis O. Andersen, M.A. L.P.NPI 1770690380

Title

Owner/Psychologist

Phone

(320) 253-4321

Specialties & licenses 4

Addresses

Other identifiers 4

Locations

Practitioners 1

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

• Dennis O. Andersen, L.P.

  • Counseling Psychologist
  • Saint Cloud, MN
  • NPI 1770690380
  NPD (past) Authorized official

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450828800000",
    "number": "1457544686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 NORTHWAY DR",
            "address_2": "SUITE 1",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034477",
            "telephone_number": "320-253-4321",
            "fax_number": "320-240-8525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 NORTHWAY DR",
            "address_2": "SUITE 1",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034477",
            "telephone_number": "320-253-4321",
            "fax_number": "320-240-8525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MINNESOTA COUSELING CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2015-12-23",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "320-253-4321",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A. L.P."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710992243",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033200233",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699882217",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770690380",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Child & Adolescent Psychologist in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Clinical Child & Adolescent Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; 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.