NPIMap

Organization Active NPI

Life Dynamics Inc

  • Clinical Psychologist
  • Prior Lake, MN
National Provider Identifier
1932543964
Registry record updated Apr 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP3631 Issued in MN
Legal business name
LIFE DYNAMICS INC
Practice address
6885 Boudin St NE
Suite 100
Prior Lake, MN 55372-1432
Phone
(952) 226-2641
Fax
(952) 226-2641
NPI assigned
Apr 21, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2013

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

Authorized official

Name
Chuck Jorenby, MA, LP
Title
Licensed Psychologist/Owner
Phone
(952) 226-2641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X LP3631 MN Primary

Addresses

Primary practice location

6885 Boudin St NE
Suite 100
Prior Lake, MN 55372-1432

Mailing address

6885 Boudin St NE
Suite 100
Prior Lake, MN 55372-1432
Phone (952) 226-2641

National Provider Directory

National Provider Directory

Locations

6885 Boudin St NE
Ste 100
Prior Lake, MN 55372
Phone (952) 226-2641

NPI Registry JSON

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

{
    "created_epoch": "1366502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366502400000",
    "number": "1932543964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6885 BOUDIN ST NE",
            "address_2": "SUITE 100",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721432",
            "telephone_number": "952-226-2641",
            "fax_number": "952-226-2641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6885 BOUDIN ST NE",
            "address_2": "SUITE 100",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721432",
            "telephone_number": "952-226-2641",
            "fax_number": "952-226-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE DYNAMICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-21",
        "last_updated": "2013-04-21",
        "status": "A",
        "authorized_official_last_name": "JORENBY",
        "authorized_official_first_name": "CHUCK",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "952-226-2641",
        "authorized_official_credential": "MA, LP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prior Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.