Thyra Anne Fossum, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4703 Issued in MN

Practice address

1595 Selby Ave
Suite 109
Saint Paul, MN 55104-6221

Phone

(612) 229-8198

NPI assigned

Nov 4, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435622400000",
    "number": "1902133440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1595 SNELLING AVENUE",
            "address_2": "SUITE 109",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "55104",
            "telephone_number": "612-229-8198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 SELBY AVE",
            "address_2": "SUITE 109",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046221",
            "telephone_number": "612-229-8198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSSUM",
        "first_name": "THYRA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-04",
        "last_updated": "2015-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arden Fortenberry, CNP
• Erika Fortin, LICSW
• Laura Fortmeyer, CRNA
• Laura Fortuna, PHARMD
• Elliott Scott Foss, PA-C
• Rachel Ann Foster Belkin, PHD
• Katherine G Foster, PA
• Lender Kaye Foster
• Rachael Ann Foster, PA-C
• Shelly Ann Foster, LICSW

• Clinical Psychologist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; 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.