MARY G MATTISON-WYNN (NPI# 1649202755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649202755 |
| Entity Type | Individual |
| Full Name | MARY G MATTISON-WYNN |
| Credential | PSY D LP |
| Practice Address |
9550 Upland Ln N Ste 120 Maple Grove MN 55369 |
| Mailing Address |
2401 Northdale Blvd Nw Ste 220 Coon Rapids MN 55433-2923 |
| Practice Telephone | 7635376000 |
| Practice Fax Number | 7635376666 |
| Mailing Telephone | 7635376000 |
| Mailing Fax Number | 7635376666 |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-06-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| Y | 103T00000X | Psychologist | LP4961 | MN | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
4961 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | P426 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3000 Carriage Dr, Hamel, MN 553409597 | 7634787395 |
| Street Address |
9550 UPLAND LN N STE 120 |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245259043 | Courtney V Freeman | Physician Assistant | 9550 Upland Ln N Ste 120, Maple Grove, MN 55369-4481 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265610851 | Tatyana V. Avdeyeva | Psychologist | 7372 Kirkwood Ct N, Maple Grove, MN 55369-5202 | 2008-02-05 |
| 1164496071 | Maple Grove Counseling Center Pa | Psychologist | 13700 83rd Way, Ste 205, Maple Grove, MN 55369-7015 | 2006-02-15 |
| 1801452768 | Steven Clifford Strickland | Psychologist | 13603 80th Cir N, Maple Grove, MN 55369-8961 | 2019-05-16 |
| 1821562000 | Amanda Exman | Psychologist | 11334 86th Ave N, Maple Grove, MN 55369-4528 | 2019-01-22 |
| 1477984433 | Ju-ping Huang | Psychologist | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2013-12-02 |
| 1023443629 | Natasha Marie Mills | Psychologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2013-09-13 |
| 1669816179 | Jennifer M Krzewina | Psychologist | 7236 Forestview Ln N, Maple Grove, MN 55369-5656 | 2013-04-26 |
| 1962759977 | Disney Counseling Resources, Pllc | Psychologist | 7225 Forestview Ln N, Maple Grove, MN 55369-5501 | 2012-08-08 |
| 1972802361 | Sally R Brinza Phd Lp LLC | Psychologist | 7225 Forestview Ln N, Maple Grove, MN 55369-5501 | 2011-03-24 |
| 1831337120 | Janeen Montgomery-peterson | Psychologist | 7270 Forestview Ln N Ste 150, Maple Grove, MN 55369-5568 | 2009-01-26 |
| Find all providers in MAPLE GROVE | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
Please comment or provide details below to improve the information on MARY G MATTISON-WYNN.
| 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.