Mara D Pease, PSYD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP6204 Issued in MN

Practice address

1600 University Ave W
Suite 12
St Paul, MN 55104

Phone

(651) 379-5157

Fax

(651) 379-5159

NPI assigned

Jun 21, 2016

Reactivated

Feb 20, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mara D Locketz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sonder Behavioral Health & Wellness, Inc.

  • Clinical Psychologist
  • Minnetonka, MN
  • NPI 1780031732
  NPD

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1548610561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 UNIVERSITY AVE W",
            "address_2": "SUITE 12",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "551043898",
            "telephone_number": "651-379-5157",
            "fax_number": "651-379-5159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 UNIVERSITY AVE W",
            "address_2": "SUITE 12",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55104",
            "telephone_number": "651-379-5157",
            "fax_number": "651-379-5159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1310 Highway 96 E",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "White Bear Lake",
            "state": "MN",
            "postal_code": "551103619",
            "country_code": "US",
            "telephone_number": "651-379-5157",
            "fax_number": "651-379-5159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEASE",
        "first_name": "MARA",
        "middle_name": "D",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-21",
        "last_updated": "2018-07-30",
        "deactivation_date": "2017-10-02",
        "reactivation_date": "2018-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP6204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARA",
            "last_name": "LOCKETZ",
            "middle_name": "D",
            "credential": "PSYD, LP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Benjamin J Peake, MD
• Jacqueline Pearl
• Joshua Pearl, PSY.D., LP
• Anija Lavae Pearson
• Kelly Ann Pearson, CNP
• Anna Pedersen, PHARM.D.
• Cynthia Ann Pedersen, OTR/L, CHT
• Tracy Pedersen, M.S., CCC-SLP
• Melissa Wheelock Pederson, PH.D., L.P.
• Patrick Pederson

• Psychologist in St Paul, MN
• Providers in St Paul, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.