Active NPI
Allen Stock, LICENSED PSYCHOLOGIS
- Clinical Psychologist
- St Louis Park, MN
National Provider Identifier
1770832875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP1450
- Practice address
- 5775 Wayzata Blvd Ste 767
St Louis Park, MN 55416-1222 - Phone
- (612) 799-6263
- NPI assigned
- Sep 5, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP1450 | MN | Primary |
Addresses
Primary practice location
5775 Wayzata Blvd Ste 767
St Louis Park, MN 55416-1222
Mailing address
5775 Wayzata Blvd Ste 767
St Louis Park, MN 55416-1222
Phone (612) 799-6263
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP1450 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678924800000",
"number": "1770832875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5775 WAYZATA BLVD STE 767",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161222",
"telephone_number": "612-799-6263",
"fax_number": "888-827-5513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5775 WAYZATA BLVD STE 767",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161222",
"telephone_number": "612-799-6263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOCK",
"first_name": "ALLEN",
"credential": "LICENSED PSYCHOLOGIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-05",
"last_updated": "2023-03-16",
"certification_date": "2023-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP1450",
"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 Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.