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General NPI Number Information
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NPI Number | 1861629206
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Entity Type | Organization
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Legal Business Name | NORTH CENTRAL PSYCHOLOGICAL CONSULTANTS, INC.
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 12760 ABERDEEN ST NE SUITE 212
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City | BLAINE
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State | MN
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Zip | 55449-5845
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Country | US
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Telephone | 651-600-2727
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Fax | 612-656-3031
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Provider Business Mailing Address
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Address Line | 12760 ABERDEEN ST NE SUITE 212
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City | BLAINE
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State | MN
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Zip | 55449-5845
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Country | US
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Telephone | 651-600-2727
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Fax | 612-656-3031
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Authorized Official
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Title or Position | CLINIC DIRECTOR/OWNER
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Name | DR. MARIE LYNN ANDERSON
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Credential | PSYD, LP, LMFT
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Telephone | 651-600-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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