Justin Coulter, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP5543 Issued in MN

Practice address

7236 Forestview Lane N.
Maple Grove, MN 55369

Phone

(763) 416-4167

Fax

(763) 416-4137

NPI assigned

Dec 9, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovative Psychological Consultants, LLCGroup PAC ID 3678596285, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Innovative Psychological Consultants, LLC

  • Addiction (Substance Use Disorder) Psychologist
  • Maple Grove, MN
  • NPI 1942221080

  MN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1228780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397779200000",
    "number": "1992940746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 2ND ST SE",
            "address_2": "# 100",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142290",
            "telephone_number": "651-235-8321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7236 FORESTVIEW LANE N.",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-416-4167",
            "fax_number": "763-416-4137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COULTER",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-09",
        "last_updated": "2014-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP5543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Coulson Chiropractic, LLC
• Andrew Robert Coulson, D.C.
• Morgan Coulson, CNP, FNP-BC
• Theresa S. Covert, M.D.
• Michaela Marie Craigan
• Ivori Darnicia Crawford, PHARMD
• Kelly Crenna, O.D.
• Lisa D. Cross, MA, LMFT

• All providers in Maple Grove, MN
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2014; 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.