NPIMap

Organization Active NPI

Addictions & Stress Clinic

Doing business as ASC Psychological Services

  • Community/Behavioral Health Agency
  • Mankato, MN
National Provider Identifier
1992085674
Registry record updated Aug 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
LP1673 Issued in MN
Legal business name
ADDICTIONS & STRESS CLINIC
Doing business as
ASC Psychological Services
Practice address
12 Civic Center PLZ
Suite 2090
Mankato, MN 56001-7781
Phone
(507) 345-4679
Fax
(507) 345-8685
NPI assigned
Aug 25, 2011
Last updated
Aug 25, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2011

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

Authorized official

Name
Dr. George V Komaridis, PH.D., LPNPI 1124297213
Title
Clinical Director
Phone
(507) 345-4679

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X LP1673 MN Primary

Addresses

Primary practice location

12 Civic Center PLZ
Suite 2090
Mankato, MN 56001-7781

Mailing address

12 Civic Center PLZ
Suite 2090
Mankato, MN 56001-7781
Phone (507) 345-4679

Other names 1

  • ASC PSYCHOLOGICAL SERVICES Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Addictions and Stress Clinics LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12 Civic Center Plz
Ste 2090
Mankato, MN 56001
Phone (507) 345-4679

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1314230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314230400000",
    "number": "1992085674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 CIVIC CENTER PLZ",
            "address_2": "SUITE 2090",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017781",
            "telephone_number": "507-345-4679",
            "fax_number": "507-345-8685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 CIVIC CENTER PLZ",
            "address_2": "SUITE 2090",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017781",
            "telephone_number": "507-345-4679",
            "fax_number": "507-345-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADDICTIONS & STRESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-25",
        "last_updated": "2011-08-25",
        "status": "A",
        "authorized_official_last_name": "KOMARIDIS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "507-345-4679",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "LP1673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASC PSYCHOLOGICAL SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; 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.