PARKSIDE PSYCHOLOGY, INC. (NPI# 1114175791) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114175791 |
| Entity Type | Organization |
| Organization Name | PARKSIDE PSYCHOLOGY, INC. |
| Practice Address |
2124 Dupont Ave S 104 Minneapolis MN 55405-2700 |
| Practice Telephone | 6128714336 |
| Practice Fax Number | 6129292331 |
| Mailing Telephone | 6128714336 |
| Mailing Fax Number | 6129292331 |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2008-09-08 |
| Authorized Official Name | DR. SALLY RUTH MOORE (PSYCHOLOGIST/OWNER) |
| Authorized Official Telephone | 6128714336 |
| Authorized Official Credential | PSY. D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
LP1891 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 621853900 | 05 | |
| MN | BCBSMN | 67Q05MO | 01 |
| Street Address |
2124 DUPONT AVE S 104 |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55405-2700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467437228 | Cara Beames | Psychologist | 2124 Dupont Ave S, Minneapolis, MN 55405-2700 | 2005-12-14 |
| 1619496023 | Jennifer Eileen Brown | Social Worker | 2124 Dupont Ave S, Minneapolis, MN 55405-2700 | 2017-09-18 |
| 1518338458 | Sarah Kenville | Counselor | 2124 Dupont Ave S, 101, Minneapolis, MN 55405-2700 | 2015-10-19 |
| 1528406774 | Marjorie Sita | Counselor | 2124 Dupont Ave S, Suite 101, Minneapolis, MN 55405-2700 | 2013-06-10 |
| 1528386257 | Townes, LLC | Clinic/Center | 2124 Dupont Ave S, Suite G1, Minneapolis, MN 55405-2700 | 2010-05-05 |
| 1639301310 | Jupiter Center, Pllc | Marriage & Family Therapist | 2124 Dupont Ave S, Suite G1, Minneapolis, MN 55405-2700 | 2009-08-14 |
| 1306038328 | Julie A Kenfield | Psychologist | 2124 Dupont Ave S, Suite 300, Minneapolis, MN 55405-2700 | 2007-08-14 |
| 1598976698 | Kenfield and Associates, P.C. | Psychologist | 2124 Dupont Ave S, Suite 300, Minneapolis, MN 55405-2700 | 2007-05-24 |
| 1538382767 | Ellen Udine Logacz | Psychologist | 2124 Dupont Ave S, Suite 301, Minneapolis, MN 55405-2700 | 2007-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003373689 | Minneapolis Health & Wellness Ne, LLC | Physical Therapist | 2125 E Hennepin Ave, Suite 300, Minneapolis, MN 55405 | 2019-03-01 |
| 1033673967 | Amy Fitzgerald | Counselor | 2915 South Wayzata Boulevard, Minneapolis, MN 55405 | 2019-01-24 |
| 1861975245 | Sara Tejani | Dentist | 2232 Hennepin Ave. S., Minneapolis, MN 55405 | 2018-09-11 |
| 1477903995 | James Albert Zeese Jr. | Psychiatry & Neurology | 2401 Laurel Avenue, Minneapolis, MN 55405 | 2016-06-15 |
| 1154786523 | Sophia Bouwens | Acupuncturist | 275 Market St Ste 409, Minneapolis, MN 55405 | 2015-12-29 |
| 1912362732 | Anna Needham | Acupuncturist | 2200 Hennepin Ave S, Minneapolis, MN 55405 | 2015-12-21 |
| 1821423740 | Aja Dionna King | Counselor | 227 Colfax Ave N Ste 15, Minneapolis, MN 55405 | 2013-09-10 |
| 1013280403 | Walgreen Co. | Durable Medical Equipment & Medical Supplies | 2100 Lyndale Ave S Ste A, Minneapolis, MN 55405 | 2012-02-15 |
| 1396022117 | Sharri Peterson Rogers | Marriage & Family Therapist | 2809 South Wayzata Blvd, Minneapolis, MN 55405 | 2011-11-08 |
| 1447577143 | Kareem Shareef Braxton | Counselor | 227 Colfax Avenue North, Suite 130, Minneapolis, MN 55405 | 2010-04-21 |
| Find all providers in zip 55405 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861008567 | Natalia V Potapova | Psychologist | 701 Park Ave # S1.110, Minneapolis, MN 55415-1623 | 2020-09-17 |
| 1962014167 | Kate Esterline | Psychologist | 2724 University Ave Se Ste B, Minneapolis, MN 55414-3210 | 2020-08-19 |
| 1831740216 | Seth Gordon Disner | Psychologist | 1 Veterans Dr # B68-2, Minneapolis, MN 55417-2309 | 2019-09-26 |
| 1366090763 | Healing Therapy LLC | Psychologist | 1813 S 6th St Ste 201, Minneapolis, MN 55454-1208 | 2019-08-28 |
| 1891340469 | Karin Fisher | Psychologist | 701 Park Ave # S1.260, Minneapolis, MN 55415-1623 | 2019-08-09 |
| 1053881698 | Lauren Michelle Scholder | Psychologist | 401 Main St Se Apt 7009, Minneapolis, MN 55414 | 2018-11-27 |
| 1902306038 | Ksa Psychological Services, LLC | Psychologist | 5603 Chicago Ave., Minneapolis, MN 55417 | 2018-02-15 |
| 1689030231 | Oliver Ross Psychology and Consulting LLC | Psychologist | 3802 Grand Ave S, Suite A, Minneapolis, MN 55409-1233 | 2016-01-13 |
| 1295100881 | Oliver Ross | Psychologist | 3802a Grand Avenue South, Minneapolis, MN 55409 | 2015-12-08 |
| 1841664190 | Lakes Wellness Center LLC | Psychologist | 3248 Stevens Ave, Minneapolis, MN 55408-3214 | 2015-11-24 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55405 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.