Provider Demographics
NPI:1861629206
Name:NORTH CENTRAL PSYCHOLOGICAL CONSULTANTS, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL PSYCHOLOGICAL CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP, LMFT
Authorized Official - Phone:651-600-2727
Mailing Address - Street 1:12760 ABERDEEN ST NE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5845
Mailing Address - Country:US
Mailing Address - Phone:651-600-2727
Mailing Address - Fax:612-656-3031
Practice Address - Street 1:12760 ABERDEEN ST NE
Practice Address - Street 2:SUITE 212
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5845
Practice Address - Country:US
Practice Address - Phone:651-600-2727
Practice Address - Fax:612-656-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty