Great Lakes Neurobehavioral Center, PC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6005 Issued in MN

Legal business name

GREAT LAKES NEUROBEHAVIORAL CENTER, PC

Practice address

7373 France Ave S
Suite 305
Edina, MN 55435-4534

Phone

(612) 382-7165

NPI assigned

Jan 27, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Melissa Fischer, PHD

Title

Neuropsychologist

Phone

(612) 382-7165

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1485475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488499200000",
    "number": "1649717778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10195 INVER GROVE TRL",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550763830",
            "telephone_number": "612-382-7165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S",
            "address_2": "SUITE 305",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354534",
            "telephone_number": "612-382-7165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES NEUROBEHAVIORAL CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-27",
        "last_updated": "2017-03-03",
        "status": "A",
        "authorized_official_last_name": "FISCHER",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "NEUROPSYCHOLOGIST",
        "authorized_official_telephone_number": "612-382-7165",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "6005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Edina, MN
• Providers in Edina, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; 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.