NPIMap

Organization Active NPI

Lacuna for Integrative Therapies

  • Cognitive & Behavioral Psychologist
  • St Louis Park, MN
National Provider Identifier
1629108410
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
License
15118 Issued in MN
Legal business name
LACUNA FOR INTEGRATIVE THERAPIES
Practice address
5009 Excelsior Blvd
Suite 134
St. Louis Park, MN 55416
Phone
(612) 360-5685
Fax
(952) 285-4103
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

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

Authorized official

Name
Joshua M KentNPI 1588689384
Title
Licsw
Phone
(651) 264-0260

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X 15118 MN Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 15118 MN

Addresses

Primary practice location

5009 Excelsior Blvd
Suite 134
St. Louis Park, MN 55416

Mailing address

5009 Excelsior Blvd
Suite 134
St. Louis Park, MN 55416
Phone (612) 360-5685

Other identifiers 1

IdentifierTypeStateIssuer
607649100MedicaidMN

Other names 1

  • Joshua M Kent, Licsw Other name

National Provider Directory

National Provider Directory

Locations

5009 Excelsior Blvd
Ste 134
St Louis Park, MN 55416
Phone (612) 360-5685

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219881600000",
    "number": "1629108410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5009 EXCELSIOR BLVD",
            "address_2": "SUITE 134",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "612-360-5685",
            "fax_number": "952-285-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5009 EXCELSIOR BLVD",
            "address_2": "SUITE 134",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "612-360-5685",
            "fax_number": "952-285-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACUNA FOR INTEGRATIVE THERAPIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-08-28",
        "status": "A",
        "authorized_official_last_name": "KENT",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "LICSW",
        "authorized_official_telephone_number": "651-264-0260"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "15118",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "15118",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "607649100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Joshua M Kent, Licsw",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 28, 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.

Verify at the official NPI Registry.