Active NPI
Child Psychology Services, LLC
- Community/Behavioral Health Agency
- Burnsville, MN
National Provider Identifier
1609095629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- LP5415
- Legal business name
- CHILD PSYCHOLOGY SERVICES, LLC
- Practice address
- 12940 Harriet Ave S
Suite 250
Burnsville, MN 55337-2680 - Phone
- (612) 284-1557
- Fax
- (952) 432-3826
- NPI assigned
- Apr 25, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Laura Sullivan Ehlert, PSY.D.
- Title
- Psychologist
- Phone
- (612) 284-1557
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | LP5415 | MN | Primary |
Addresses
Primary practice location
12940 Harriet Ave S
Suite 250
Burnsville, MN 55337-2680
Mailing address
12940 Harriet Ave S
Suite 250
Burnsville, MN 55337-2680
Phone (612) 284-1557
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 66G85CH | Other | MN | BLUE CROSS BUSINESS |
| 218191033686 | Other | MN | PREFERRED ONE |
National Provider Directory
National Provider DirectoryLocations
12940 Harriet Ave S
Ste 250
Burnsville, MN 55337
Phone (612) 284-1557
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Child & Adolescent Psychologist
- Burnsville, MN
- NPI 1558469353
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177459200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1371600000000",
"number": "1609095629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12940 HARRIET AVE S",
"address_2": "SUITE 250",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553372680",
"telephone_number": "612-284-1557",
"fax_number": "952-432-3826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12940 HARRIET AVE S",
"address_2": "SUITE 250",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553372680",
"telephone_number": "612-284-1557",
"fax_number": "952-432-3826"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHILD PSYCHOLOGY SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-25",
"last_updated": "2013-06-19",
"status": "A",
"authorized_official_last_name": "EHLERT",
"authorized_official_first_name": "LAURA",
"authorized_official_middle_name": "SULLIVAN",
"authorized_official_title_or_position": "PSYCHOLOGIST",
"authorized_official_telephone_number": "612-284-1557",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PSY.D."
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "MN",
"license": "LP5415",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BUSINESS",
"identifier": "66G85CH",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "218191033686",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.