Healthcare Provider Details

I. General information

NPI: 1811162746
Provider Name (Legal Business Name): ADVANCED PRACTICE PSYC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SINGLETREE LN STE 312
EDEN PRAIRIE MN
55344-5398
US

IV. Provider business mailing address

11800 SINGLETREE LN STE 312
EDEN PRAIRIE MN
55344-5398
US

V. Phone/Fax

Practice location:
  • Phone: 952-322-8532
  • Fax: 952-322-8513
Mailing address:
  • Phone: 952-322-8532
  • Fax: 952-322-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY MARGARET ANDERSEN
Title or Position: CLINICAL NURSE SPECIALIST
Credential: APRN, CNS, MSN
Phone: 952-322-8532