Provider Demographics
NPI:1649378019
Name:AURORA PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:AURORA PSYCHOLOGICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:EMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-274-1203
Mailing Address - Street 1:4660 SLATER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4047
Mailing Address - Country:US
Mailing Address - Phone:651-882-6299
Mailing Address - Fax:651-683-0057
Practice Address - Street 1:4660 SLATER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4047
Practice Address - Country:US
Practice Address - Phone:651-882-6299
Practice Address - Fax:651-882-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4645103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN83G50OLOtherBLUE CROSS BLUE SHIELD
MN084673200Medicaid
MN138155OtherUCARE
MNHP58813OtherHEALTH PARTNERS
MN680002098Medicare ID - Type Unspecified