Psychological Consultants of So MN PA

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

PSYCHOLOGICAL CONSULTANTS OF SO MN PA

Practice address

4663 White Bear Pkwy
White Bear Lake, MN 55110-3300

Phone

(612) 508-9309

NPI assigned

Mar 21, 2007

Organization subpart

No

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

Authorized official

Name

Paul Reitman, PH.D.

Title

Owner

Phone

(612) 508-9309

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dena Bohn, PSYD, LP

  • Psychologist
  • Oakdale, MN
  • NPI 1821049719
  NPD (past)

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367193600000",
    "number": "1841316015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3230 ORCHARD CT",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551105385",
            "telephone_number": "612-508-9309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4663 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103300",
            "telephone_number": "612-508-9309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL CONSULTANTS OF SO MN PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2013-04-29",
        "status": "A",
        "authorized_official_last_name": "REITMAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-508-9309",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "452444600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS MINNESOTA",
            "identifier": "41511PS",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1007131",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittani Amber Marie Porter, LPCC, LADC
• Post Acute Pharmacy Consulting
• Zachary Vincent Post, DC
• Premise Health of Minnesota Medical PC (Pipe Trades Services MN Family Health & Wellness Centers)
• Ernest Joseph Price, STUDENT
• Psychological&Behavioralconsultantspa
• Kevin Matthew Quaas, DC
• Quast Clinic LLC
• Sean Cameron Quast, D.C.
• R.J. Sass, Inc. (Sass Chiropractic Center)

• Psychologist in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2013; 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.