Mary Phillips, M.A., L.P.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP 4021 Issued in MN

Practice address

633 Main St NW Apt 220
Elk River, MN 55330-1792

Phone

(612) 422-0890

NPI assigned

Nov 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Glasswing Counseling and Wellness LLCGroup PAC ID 7113361734, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Glasswing Counseling and Wellness, LLC

  • Mental Health Counselor
  • Princeton, MN
  • NPI 1568033215
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644624000000",
    "number": "1972677979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 MAIN ST NW APT 220",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301792",
            "telephone_number": "612-422-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 MAIN ST NW APT 220",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301792",
            "telephone_number": "612-422-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "M.A., L.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2022-02-12",
        "certification_date": "2022-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP 4021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHCP",
            "identifier": "877934100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peterson Family Living
• Christopher Lee Peterson
• Sheila Renee Peterson
• Candyce Rose Petron
• James Edward Petters, PT
• William Picconatto, P.T.
• Nancy Jean Pierro, NP
• Jodi Marie Pikula, MT
• Aaron Pinion, DO
• Britley Diane Plautz

• Clinical Psychologist in Elk River, MN
• Providers in Elk River, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2022; 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.