MEDICARE: NORTH CENTRAL PSYCHOLOGICAL CONSULTANTS, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist
3	103TC0700X	Clinical Psychologist
4	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1861629206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CENTRAL PSYCHOLOGICAL CONSULTANTS, INC.

Provider Business Mailing Address
First Line	:	12760 ABERDEEN ST NE
Second Line	:	SUITE 212
City	:	BLAINE
State	:	MN
Zip	:	55449-5845
Country	:	US
Telephone Number	:	651-600-2727
Fax Number	:	612-656-3031

Provider Business Practice Location Address
First Line	:	12760 ABERDEEN ST NE
Second Line	:	SUITE 212
City	:	BLAINE
State	:	MN
Zip	:	55449-5845
Country	:	US
Telephone Number	:	651-600-2727
Fax Number	:	612-656-3031

Authorized Official
Title or Position	:	CLINIC DIRECTOR/OWNER
Name	:	DR. MARIE LYNN ANDERSON
Credential	:	PSYD, LP, LMFT
Telephone Number	:	651-600-2727

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	08/28/2013

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