Active NPI
Anna Leigh Tierney
- Clinical Psychologist
- St Louis Park, MN
National Provider Identifier
1699050179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP5538
- Practice address
- 5354 Parkdale Dr
#2
St Louis Park, MN 55416-1603 - Phone
- (651) 645-5323
- Fax
- (952) 746-5962
- NPI assigned
- Oct 17, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2011004602 | MO | |
| Clinical Psychologist | 103TC0700X | LP5538 | MN | Primary |
Addresses
Primary practice location
5354 Parkdale Dr
#2
St Louis Park, MN 55416-1603
Mailing address
5354 Parkdale Dr
#2
St Louis Park, MN 55416-1603
Phone (651) 645-5323
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP5538 | MN | MD | Clinical Psychologist |
| 2011004602 | MO | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Webster Wellness Professionals Inc | Past | Accepting new patients | |
| The Emily Program | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Illness Community Based Residential Treatment Facility
- Saint Paul, MN
- NPI 1649309246
-
- Psychologist
- Saint Louis, MO
- NPI 1639494891
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353888000000",
"number": "1699050179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5354 PARKDALE DR",
"address_2": "#2",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161603",
"telephone_number": "651-645-5323",
"fax_number": "925-746-5962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5354 PARKDALE DR",
"address_2": "#2",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161603",
"telephone_number": "651-645-5323",
"fax_number": "952-746-5962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIERNEY",
"first_name": "ANNA",
"middle_name": "LEIGH",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-17",
"last_updated": "2012-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "2011004602",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP5538",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Nov 26, 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.