Active NPI
Douglas J Latuseck, PSYD, LP
- Clinical Psychologist
- Lino Lakes, MN
National Provider Identifier
1528264488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP4822
- Practice address
- 7525 4TH Ave
Lino Lakes, MN 55014-1006 - Phone
- (651) 717-6549
- Fax
- (651) 717-6697
- NPI assigned
- Jun 26, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP4822 | MN | Primary |
Addresses
Primary practice location
7525 4TH Ave
Lino Lakes, MN 55014-1006
Mailing address
7525 4TH Ave
Lino Lakes, MN 55014-1006
Phone (651) 717-6549
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 |
|---|---|---|---|
| LP4822 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196208000000",
"number": "1528264488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7525 4TH AVE",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550141006",
"telephone_number": "651-717-6549",
"fax_number": "651-717-6697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7525 4TH AVE",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550141006",
"telephone_number": "651-717-6549",
"fax_number": "651-717-6697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LATUSECK",
"first_name": "DOUGLAS",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PSYD, LP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-26",
"last_updated": "2007-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP4822",
"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 Nov 28, 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.