Active NPI
Mary Breitenbucher, PHD, LP
- Psychologist
- Thief River Falls, MN
National Provider Identifier
1801033824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP0394
- Practice address
- 120 Labree Ave S
Thief River Falls, MN 56701-2840 - Phone
- (218) 683-4351
- Fax
- (218) 683-4362
- NPI assigned
- Jan 13, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP0394 | MN | Primary |
Addresses
Primary practice location
120 Labree Ave S
Thief River Falls, MN 56701-2840
Mailing address
120 Labree Ave S
Thief River Falls, MN 56701-2840
Phone (218) 683-4351
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231804800000",
"number": "1801033824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 LABREE AVE S",
"city": "THIEF RIVER FALLS",
"state": "MN",
"postal_code": "567012840",
"telephone_number": "218-683-4351",
"fax_number": "218-683-4362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 LABREE AVE S",
"city": "THIEF RIVER FALLS",
"state": "MN",
"postal_code": "567012840",
"telephone_number": "218-683-4351",
"fax_number": "218-683-4362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREITENBUCHER",
"first_name": "MARY",
"credential": "PHD, LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-13",
"last_updated": "2009-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP0394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Thief River Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.