Morgan Bobo
Individual provider Active NPI Clinical Psychologist · Champlin, MN
NPI 1629600010 · NPPES record last updated Feb 13, 2025
Key facts
- NPI
- 1629600010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- LP6774 (MN)
- Practice address
- 11165 Zealand Ave N
Champlin, MN 55316-3595 - Phone
- (612) 584-0966
- NPI assigned
- Feb 4, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2020
- Medicare assignment
- May accept Medicare assignment
- Group practices
- North Therapy and Wellness PA
Innovative Psychological Consultants, LLC
Practice addresses (Care Compare)
11165 Zealand Ave N
Champlin, MN 55316-3595
Phone 7635310566106
7236 Forestview LN N
Maple Grove, MN 55369-5656
Phone (763) 416-4167
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240710000158 | MN | Practitioner - Clinical Psychologist | 4183169550 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP6774 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Therapy and Wellness PA | Current |
Accepting new patients |
Locations
11165 Zealand Ave N
Champlin, MN 55316
Phone (763) 531-0566
6120 Earle Brown Dr
Ste 520
Minneapolis, MN 55430
Phone (763) 531-0566
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | LP6774 | MN | Yes |
Addresses
Primary practice location
11165 Zealand Ave N
Champlin, MN 55316-3595
Mailing address
11165 Zealand Ave N
Champlin, MN 55316-3595
Phone (763) 531-0566
Other providers in Champlin, MN
- Amy Bianchi-Rossi
- Bickford of Champlin, LLC
- Bio-Medical Applications of Minnesota, Inc.
- Alexander W Blidi
- Ashley A Bliss
- Matthew L Boelter
- Eftu Omer Boru
- Faisale Sale Boukari
- Brist Chiropractic & Naturopathic Wellness Center LLC
- Jeff Brist
All providers in Champlin, MN · Clinical Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.