Provider Demographics
NPI:1871619577
Name:ANDERSON PSYCHOLOGICAL SERVICES, L.L.C.
Entity type:Organization
Organization Name:ANDERSON PSYCHOLOGICAL SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:612-374-2400
Mailing Address - Street 1:15 GROVELAND TER
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1154
Mailing Address - Country:US
Mailing Address - Phone:612-374-2400
Mailing Address - Fax:612-374-2401
Practice Address - Street 1:15 GROVELAND TER
Practice Address - Street 2:SUITE 302
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1154
Practice Address - Country:US
Practice Address - Phone:612-374-2400
Practice Address - Fax:612-374-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN119099Medicare UPIN
MN7903877Medicare UPIN
MN61-90438Medicare UPIN