Prairie Psychological Services PA

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PRAIRIE PSYCHOLOGICAL SERVICES PA

Practice address

205 W Fletcher St
Crookston, MN 56716-1945

Phone

(281) 281-2117

NPI assigned

Apr 7, 2010

Last updated

Jul 14, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David G Jansen, PH.D.

Title

Owner and Director

Phone

(218) 281-2117

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310601600000",
    "number": "1740506393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W FLETCHER ST",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161945",
            "telephone_number": "281-281-2117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W FLETCHER ST",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161945",
            "telephone_number": "281-281-2117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE PSYCHOLOGICAL SERVICES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-07",
        "last_updated": "2011-07-14",
        "status": "A",
        "authorized_official_last_name": "JANSEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER AND DIRECTOR",
        "authorized_official_telephone_number": "218-281-2117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330748400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6192932",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "63658PR",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David C Peterson, DPM
• Stephanie Kaitlyn Philyaw
• Polk County Auditor (Polk County Public Health)
• Polk County Social Services
• Polk-Norman-Mahnomen Community Health Board
• Breanna J. Privratsky, PA-C
• Nicole Qual, D.C.
• Norma Lynette Quam
• Jacqueline Kay Ramsey
• Jessica Jo Randberg

• Community/Behavioral Health Agency in Crookston, MN
• Providers in Crookston, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2011; 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.