Individual provider Active NPI

Tharaki Siyaguna

  • Clinical Psychologist
  • Moorhead, MN
National Provider Identifier
1821571159
Registry record updated Oct 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP6711 Issued in MN
Practice address
1547 30TH Ave S
Moorhead, MN 56560-5055
Phone
(218) 287-4338
Fax
(218) 287-5928
NPI assigned
Sep 12, 2018
Last updated
Oct 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP6711 MN Primary
Specialist 174400000X NU

Addresses

Primary practice location

1547 30TH Ave S
Moorhead, MN 56560-5055

Mailing address

1547 30TH Ave S
Moorhead, MN 56560-5055
Phone (218) 287-4338

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211013000835 MN Practitioner - Clinical Psychologist 1557769171 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Solutions Behavioral Healthcare Professionals PCGroup PAC ID 0345209524, 30 clinicians

Practice addresses (Care Compare)

1547 30TH Ave S
Moorhead, MN 56560-5149
Phone (218) 287-4338

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Solutions Behavioral Healthcare Professionals, PC Clinical CurrentSince Oct 5, 2021 Accepting new patients

Locations

1041 Hawk St
Detroit Lakes, MN 56501
Phone (218) 844-6853

1547 30th Ave S
Moorhead, MN 56560
Phone 21828743381113

891 Belsly Blvd
Moorhead, MN 56560
Phone (701) 412-2973

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1821571159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1547 30TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605055",
            "telephone_number": "218-287-4338",
            "fax_number": "218-287-5928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1547 30TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605055",
            "telephone_number": "218-287-4338",
            "fax_number": "218-287-5928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIYAGUNA",
        "first_name": "THARAKI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-12",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6711",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

Verify at the official NPI Registry.