MEDICARE: DICKSON PSYCHIATRIC SERVICES, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP-1591	MN

General Provider Information

NPI Number	:	1295167880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DICKSON PSYCHIATRIC SERVICES, PLC

Provider Business Mailing Address
First Line	:	6357 MERRIMAC LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3835
Country	:	US
Telephone Number	:	218-256-7570
Fax Number	:	877-514-9201

Provider Business Practice Location Address
First Line	:	1409 WILLOW ST STE 201
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3254
Country	:	US
Telephone Number	:	763-200-6161
Fax Number	:	877-514-9201

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	DR. TODD ALAN DICKSON
Credential	:	DNP, APRN, PMHNP
Telephone Number	:	218-256-7570

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	04/12/2026

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