Active NPI
Brian Edward Powers II, PHD
- Clinical Psychologist
- St Louis Park, MN
National Provider Identifier
1558383794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2546
- Practice address
- 4500 Park Glen Rd
Suite 155
St Louis Park, MN 55416-4871 - Phone
- (612) 986-4397
- Fax
- (952) 495-1409
- NPI assigned
- Jul 24, 2006
- Last updated
- Sep 5, 2024
- 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 | 2546 | MN | Primary |
Addresses
Primary practice location
4500 Park Glen Rd
Suite 155
St Louis Park, MN 55416-4871
Mailing address
4500 Park Glen Rd
Suite 155
St Louis Park, MN 55416-4871
Phone (612) 986-4397
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5H617PO | Other | MN | BLUE CROSS ID |
| 61-42917 | Other | MN | UBH ID |
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 |
|---|---|---|---|
| 2546 | MN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cedar Hill Therapy, LLC | Marriage & Family Therapist | Past | Accepting new patients |
| The Lake Group LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Mound Psychological Services
- Psychologist
- St Louis Park, MN
- NPI 1346471232
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725494400000",
"number": "1558383794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 PARK GLEN RD",
"address_2": "SUITE 155",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554164871",
"telephone_number": "612-986-4397",
"fax_number": "952-495-1409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 PARK GLEN RD",
"address_2": "SUITE 155",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554164871",
"telephone_number": "612-986-4397",
"fax_number": "952-495-1409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWERS",
"first_name": "BRIAN",
"middle_name": "EDWARD",
"name_suffix": "II",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2024-09-05",
"certification_date": "2024-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "2546",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS ID",
"identifier": "5H617PO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH ID",
"identifier": "61-42917",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.