Psychology Services of Minnesota, PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3464 Issued in MN

Legal business name

PSYCHOLOGY SERVICES OF MINNESOTA, PLLC

Practice address

804 Wright St
Brainerd, MN 56401-4441

Phone

(218) 829-1407

NPI assigned

May 10, 2018

Organization subpart

No

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

Authorized official

Name

Kevin James Edwards, PH.D., LP

Title

Psychologist

Phone

(218) 330-7867

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1841780335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15748 BIRCHWOOD LN",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564016176",
            "telephone_number": "218-330-7867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 WRIGHT ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564014441",
            "telephone_number": "218-829-1407"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15748 Birchwood Ln",
            "address_purpose": "LOCATION",
            "city": "Brainerd",
            "state": "MN",
            "postal_code": "564016176",
            "country_code": "US",
            "telephone_number": "218-330-7867",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "610 Summit Dr",
            "address_purpose": "LOCATION",
            "city": "Fairmont",
            "state": "MN",
            "postal_code": "560312247",
            "country_code": "US",
            "telephone_number": "218-330-7867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSYCHOLOGY SERVICES OF MINNESOTA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-10",
        "last_updated": "2019-04-11",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "218-330-7867",
        "authorized_official_credential": "PH.D., LP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "3464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; 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.