Northern Lights Psychological Services P.a.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LP4330 Issued in MN

Legal business name

NORTHERN LIGHTS PSYCHOLOGICAL SERVICES P.A.

Practice address

1010 Frontier Dr
Suite 104
Fergus Falls, MN 56537-1023

Phone

(507) 828-1433

NPI assigned

Oct 14, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Angela A Kennedy, PSY.D., L.P.

Title

Ceo

Phone

(507) 828-1433

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1350172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350172800000",
    "number": "1619229754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3",
            "city": "UNDERWOOD",
            "state": "MN",
            "postal_code": "565860003",
            "telephone_number": "507-828-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 FRONTIER DR",
            "address_2": "SUITE 104",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371023",
            "telephone_number": "507-828-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIGHTS PSYCHOLOGICAL SERVICES P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-14",
        "last_updated": "2012-10-14",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-828-1433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D., L.P."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "LP4330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6178609",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "589175200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "978T6PS",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charis Helen Nielsen, RN
• Dennis D. Nims, MSW
• Kristy Norenberg, MPH, RD
• Northern Lakes Dental - Riverfront, LLC
• Northern Lakes Dental, LTD.
• Robert S Noyes, MD
• Tanner Nygaard
• Jerra Cori Nylund
• Brandi Ochoa
• Debra Lynn Ochocki, RN

• Community/Behavioral Health Agency in Fergus Falls, MN
• Providers in Fergus Falls, 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 Oct 14, 2012; 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.