Great River Psychological Services, P.a.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3903 Issued in MN

Legal business name

GREAT RIVER PSYCHOLOGICAL SERVICES, P.A.

Practice address

403 4TH St NW
Suite 245
Bemidji, MN 56601-3142

Phone

(218) 444-6912

Fax

(218) 444-6937

NPI assigned

Apr 7, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Jean Ann Christensen, PSYD,

Title

Psychologist, Owner

Phone

(218) 759-1576

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1952544934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 4TH ST NW",
            "address_2": "SUITE 245",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013142",
            "telephone_number": "218-444-6912",
            "fax_number": "218-444-6937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 4TH ST NW",
            "address_2": "SUITE 245",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013142",
            "telephone_number": "218-444-6912",
            "fax_number": "218-444-6937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVER PSYCHOLOGICAL SERVICES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-07",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PSYCHOLOGIST, OWNER",
        "authorized_official_telephone_number": "218-759-1576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD,"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; 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.