Psychological Healthcare of Minnesota PA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP 2224 Issued in MN

Legal business name

PSYCHOLOGICAL HEALTHCARE OF MINNESOTA PA

Practice address

15798 Venture LN
Eden Prairie, MN 55344-5729

Phone

(952) 920-2789

Fax

(952) 746-3890

NPI assigned

Oct 28, 2008

Last updated

Mar 9, 2009By 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. Douglas Guthrie Frey, PH.D.NPI 1649317413

Title

President

Phone

(952) 920-2789

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Douglas G. Frey, PH.D.

  • Clinical Psychologist
  • Eden Prairie, MN
  • NPI 1649317413
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236556800000",
    "number": "1821241340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15798 VENTURE LN",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445729",
            "telephone_number": "952-920-2789",
            "fax_number": "952-746-3890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15798 VENTURE LN",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445729",
            "telephone_number": "952-920-2789",
            "fax_number": "952-746-3890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL HEALTHCARE OF MINNESOTA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2009-03-09",
        "status": "A",
        "authorized_official_last_name": "FREY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "GUTHRIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-920-2789",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP 2224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; 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.