NPIMap

Organization Active NPI

Innovative Psychological Consultants, LLC

  • Addiction (Substance Use Disorder) Psychologist
  • Maple Grove, MN
National Provider Identifier
1942221080
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X
License
LP4615 Issued in MN
Legal business name
INNOVATIVE PSYCHOLOGICAL CONSULTANTS, LLC
Practice address
7372 Kirkwood CT
Maple Grove, MN 55369-5202
Phone
(763) 416-4167
Fax
(763) 416-4137
NPI assigned
Jul 22, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Christian Todd Anderson, PSY.D.NPI 1881618817
Title
Ceo
Phone
(763) 416-4167

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TA0400X LP4615 MN Primary
Counseling PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC1900X LP4615 MN

Addresses

Primary practice location

7372 Kirkwood CT
Maple Grove, MN 55369-5202

Mailing address

7372 Kirkwood CT
Maple Grove, MN 55369-5202
Phone (763) 416-4167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060110000633 MN Part B Supplier - Clinic/Group Practice 3678596285 Receives reassigned benefits from 22 practitioners
Practice locations: Maple Grove, MN

National Provider Directory

National Provider Directory

Locations

13700 83rd Way N
Ste 210
Maple Grove, MN 55369
Phone (763) 213-2576

7236 Forestview Ln N
Maple Grove, MN 55369
Phone (763) 416-4167

7270 Forestview Ln N
Ste 150
Maple Grove, MN 55369
Phone (763) 416-4157

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1942221080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7372 KIRKWOOD CT",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695202",
            "telephone_number": "763-416-4167",
            "fax_number": "763-416-4137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7372 KIRKWOOD CT",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695202",
            "telephone_number": "763-416-4167",
            "fax_number": "763-416-4137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PSYCHOLOGICAL CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-416-4167",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "LP4615",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP4615",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.