Active NPI
Greg J Pelletier, PHD LP
- Clinical Psychologist
- St Cloud, MN
National Provider Identifier
1558310102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP2723
- Practice address
- 1900 Centracare Circle
Centracare Health Plaza
St Cloud, MN 56303 - Phone
- (320) 229-4977
- Fax
- (320) 656-7058
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
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 | LP2723 | MN | Primary |
Addresses
Primary practice location
1900 Centracare Circle
Centracare Health Plaza
St Cloud, MN 56303
Mailing address
1406 6TH Ave N
St Cloud, MN 56303
Phone (320) 251-2700
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2723 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199923200000",
"number": "1558310102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1406 6TH AVE N",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "56303",
"telephone_number": "320-251-2700",
"fax_number": "320-656-7026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 CENTRACARE CIRCLE",
"address_2": "CENTRACARE HEALTH PLAZA",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "56303",
"telephone_number": "320-229-4977",
"fax_number": "320-656-7058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLETIER",
"first_name": "GREG",
"middle_name": "J",
"credential": "PHD LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2008-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP2723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.