Bradley Robert Nelson, MALP

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

LP0590 Issued in MN

Practice address

215 SE 2ND Ave
Grand Rapids, MN 55744-3615

Phone

(218) 326-1274

Fax

(218) 326-9787

NPI assigned

Jul 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 6

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

Specialty

Clinical Psychologist

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northland Counseling Center IncGroup PAC ID 1153389242, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Northland Counseling Center, Inc.

  • Community/Behavioral Health Agency
  • Grand Rapids, MN
  • NPI 1164610986
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1902822919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 SE 2ND AVE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443615",
            "telephone_number": "218-326-1274",
            "fax_number": "218-326-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 SE 2ND AVE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443615",
            "telephone_number": "218-326-1274",
            "fax_number": "218-326-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "BRADLEY",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "MALP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "LP0590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6275968",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "160767",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "3032501",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "97026",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121052100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4K585NE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John A Moran, M.D.
• Reid Morrissey, PT, ATC
• Katherine Mostoller
• Jody Murphy, PMHNP-BC
• Keith Murphy, M.D.
• Dannielle Chantel Chesness Nelson
• Makenna Pearl Nelson
• Patrick James Nelson, PA
• Sheri Nesdahl
• New Beginnings Counseling LLC (New Beginnings Counseling)

• Cognitive & Behavioral Psychologist in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Cognitive & Behavioral Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.