Integrative Psychological Services, P.a.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP4319 Issued in MN

Legal business name

INTEGRATIVE PSYCHOLOGICAL SERVICES, P.A.

Practice address

10480 Perkins Ave N
Stillwater, MN 55082-9273

Phone

(651) 357-3216

Fax

(651) 430-8085

NPI assigned

Jun 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mary Genevieve Freitag, PSY.D., L.P.

Title

Licensed Clinical Psychologist

Phone

(651) 357-3216

Specialties & licenses 2

Addresses

Other identifiers 9

Locations

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1548465883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10480 PERKINS AVE N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550829273",
            "telephone_number": "651-357-3216",
            "fax_number": "651-430-8085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10480 PERKINS AVE N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550829273",
            "telephone_number": "651-357-3216",
            "fax_number": "651-430-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE PSYCHOLOGICAL SERVICES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "FREITAG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "GENEVIEVE",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "651-357-3216",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D., L.P."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4319",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "74G37FR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "028H0HA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "HP33776",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST",
            "identifier": "103T00000X",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "130952",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0492456",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "1028022",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "1382591",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "61-57516",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.