Douglas Pelcak, MA

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

3919 W 44TH St
200
Edina, MN 55424-1032

Phone

(952) 934-0678

NPI assigned

May 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Institute for Therapy & Behavior Change, LTD.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Edina, MN
  • NPI 1548488331
  NPD (past)

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457572638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9770 GARRISON WAY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553473039",
            "telephone_number": "612-998-4313",
            "fax_number": "952-988-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 W 44TH ST",
            "address_2": "200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554241032",
            "telephone_number": "952-934-0678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELCAK",
        "first_name": "DOUGLAS",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scot A. Pearson, D.C.
• Cortney Pederson, MSW LICSW
• Erin Therese Pederson, CNP, FNP-C
• Lane Daniel Pederson, PSYD LP
• Pediatric Neuropsychology Services, P.C.
• Katherine Mary Pellant Kaufman, ATC
• Avi Mae Pelly, RDN
• Kyra Marie Peloquin, PT, DPT
• Stephen Peltier, D.C.
• Heidi Peluf, COTA/L

• Counselor in Edina, MN
• Providers in Edina, MN by specialty
• Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.