NPIMap

Organization Active NPI

Mankato Psychology Clinic, PLC

  • Mental Health Counselor
  • Mankato, MN
National Provider Identifier
1679628192
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1926616 Issued in MN
Legal business name
MANKATO PSYCHOLOGY CLINIC, PLC
Practice address
209 S 2ND St
Suite 306
Mankato, MN 56001-3626
Phone
(507) 387-1350
Fax
(507) 387-6605
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Peggysue Hesse, LP
Title
Owner, Partner
Phone
(507) 387-1350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 1926616 MN Primary

Addresses

Primary practice location

209 S 2ND St
Suite 306
Mankato, MN 56001-3626

Mailing address

209 S 2ND St
Suite 306
Mankato, MN 56001-3626
Phone (507) 387-1350

Other identifiers 5

IdentifierTypeStateIssuer
81G62MAOtherMNBLUE CROSS
114490OtherMNUCARE
6H521MAOtherMNBLUE CROSS
6H520MAOtherMNBLUE CROSS
155H1MAOtherMNBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060206000542 MN Part B Supplier - Clinic/Group Practice 0941214381 Receives reassigned benefits from 4 practitioners
Practice locations: Mankato, MN

National Provider Directory

National Provider Directory

Locations

209 S 2nd St
Ste 306
Mankato, MN 56001
Phone (507) 387-1143

Practitioners & affiliated clinicians

Practitioners 9

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": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679628192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 S 2ND ST",
            "address_2": "SUITE 306",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013626",
            "telephone_number": "507-387-1350",
            "fax_number": "507-387-6605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 S 2ND ST",
            "address_2": "SUITE 306",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013626",
            "telephone_number": "507-387-1350",
            "fax_number": "507-387-6605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANKATO PSYCHOLOGY CLINIC, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "PEGGYSUE",
        "authorized_official_title_or_position": "OWNER, PARTNER",
        "authorized_official_telephone_number": "507-387-1350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "1926616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "81G62MA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "114490",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "6H521MA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "6H520MA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "155H1MA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.