Professional Psychological Services, LTD

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

16437 Issued in MN

Legal business name

PROFESSIONAL PSYCHOLOGICAL SERVICES, LTD

Practice address

3352 Sherman CT
Suite 104
Eagan, MN 55121-5003

Phone

(651) 353-0133

Fax

(651) 905-0464

NPI assigned

Jan 8, 2009

Organization subpart

No

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

Authorized official

Name

Kathleen Margaret Borer, RN., LICSWNPI 1821052960

Title

Ceo/President

Phone

(651) 353-0133

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kathleen Margaret Borer, RN., LICSW

  • Clinical Social Worker
  • Ramsey, MN
  • NPI 1821052960
  NPD (past) Authorized official

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

{
    "created_epoch": "1231372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1578700878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 HAMPSHIRE DR",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201932",
            "telephone_number": "651-353-0133",
            "fax_number": "651-905-0464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3352 SHERMAN CT",
            "address_2": "SUITE 104",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551215003",
            "telephone_number": "651-353-0133",
            "fax_number": "651-905-0464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PSYCHOLOGICAL SERVICES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-08",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "BORER",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "MARGARET",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "651-353-0133",
        "authorized_official_credential": "RN., LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "16437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "877621100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Eagan, MN
• Providers in Eagan, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; 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.