NPIMap

Organization Active NPI

Minnesota Psychological Resources

  • Clinical Social Worker
  • Plymouth, MN
National Provider Identifier
1497820039
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
801884-1-MHC Issued in MN
Legal business name
MINNESOTA PSYCHOLOGICAL RESOURCES
Practice address
12805 Highway 55
Suite 211
Plymouth, MN 55441-3859
Phone
(763) 550-9005
Fax
(763) 559-2118
NPI assigned
Nov 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
David Mellberg, PH.D., L.P.
Title
Director
Phone
(763) 550-9005

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 801884-1-MHC MN
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 801884-1-MHC MN
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 801884-1-MHC MN
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X 801884-1-MHC MN
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 801884-1-MHC MN Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 801884-1-MHC MN

Addresses

Primary practice location

12805 Highway 55
Suite 211
Plymouth, MN 55441-3859

Mailing address

12805 Highway 55
Suite 211
Plymouth, MN 55441-3859
Phone (763) 550-9005

National Provider Directory

National Provider Directory

Locations

12805 Highway 55
Ste 211
Plymouth, MN 55441
Phone (763) 550-9005

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1497820039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12805 HIGHWAY 55",
            "address_2": "SUITE 211",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413859",
            "telephone_number": "763-550-9005",
            "fax_number": "763-559-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12805 HIGHWAY 55",
            "address_2": "SUITE 211",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413859",
            "telephone_number": "763-550-9005",
            "fax_number": "763-559-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA PSYCHOLOGICAL RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MELLBERG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "763-550-9005",
        "authorized_official_credential": "PH.D., L.P."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "801884-1-MHC",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "801884-1-MHC",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "801884-1-MHC",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "801884-1-MHC",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "801884-1-MHC",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "801884-1-MHC",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.