| Innovative Psychological Consultants, Llc | |
|
7372 Kirkwood Ct Maple Grove MN 55369-5202 | |
| (763) 416-4167 | |
| (763) 416-4137 |
| Full Name | Innovative Psychological Consultants, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 7372 Kirkwood Ct, Maple Grove, Minnesota |
| Authorized Official Name and Position | Christian Todd Anderson (CEO) |
| Authorized Official Contact | 7634164167 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Psychological Consultants, Llc 7372 Kirkwood Ct Maple Grove MN 55369-5202 Ph: (763) 416-4167 | Innovative Psychological Consultants, Llc 7372 Kirkwood Ct Maple Grove MN 55369-5202 Ph: (763) 416-4167 |
| NPI Number | 1942221080 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3678596285 |
|---|---|
| Medicare Enrollment ID | O20060110000633 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942221080 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | LP4615 (Minnesota) | Primary |
| 103TC1900X | Psychologist - Counseling | LP4615 (Minnesota) | Primary |
| Provider Name | Thomas A Converse |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255498556 PECOS PAC ID: 1658399753 Enrollment ID: I20051108000024 |
| Provider Name | Ranji Varghese |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255304770 PECOS PAC ID: 5890714083 Enrollment ID: I20051116000987 |
| Provider Name | Christian T Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881618817 PECOS PAC ID: 8921021536 Enrollment ID: I20060110000672 |
| Provider Name | Xan K Banker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427078260 PECOS PAC ID: 0446253314 Enrollment ID: I20060814000498 |
| Provider Name | Jennifer G Enstad |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093725467 PECOS PAC ID: 1254337918 Enrollment ID: I20061020000130 |
| Provider Name | Tara Bauman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649311150 PECOS PAC ID: 5395802953 Enrollment ID: I20090325000775 |
| Provider Name | Michael Brendan Osullivan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962547901 PECOS PAC ID: 2163555046 Enrollment ID: I20100728001141 |
| Provider Name | David J Mair |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083655898 PECOS PAC ID: 7517130057 Enrollment ID: I20111028000543 |
| Provider Name | Christina Franklin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568748291 PECOS PAC ID: 6709053606 Enrollment ID: I20120117000862 |
| Provider Name | Janeen M Montgomery-peterson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831337120 PECOS PAC ID: 6406016054 Enrollment ID: I20120320000223 |
| Provider Name | Judy K Brunsgaard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306115969 PECOS PAC ID: 7911162490 Enrollment ID: I20120709000031 |
| Provider Name | Justin T Coulter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992940746 PECOS PAC ID: 6608021258 Enrollment ID: I20130305000120 |
| Provider Name | Jeanne Bailey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306971213 PECOS PAC ID: 2567607930 Enrollment ID: I20130408000247 |
| Provider Name | Rebel Krista Gustafson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407061047 PECOS PAC ID: 4789804899 Enrollment ID: I20141013000072 |
| Provider Name | Natalie A Tobeck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427415082 PECOS PAC ID: 1153617162 Enrollment ID: I20160901001944 |
| Provider Name | Gladys Ayiera Ndege |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659045391 PECOS PAC ID: 7719385293 Enrollment ID: I20211014000025 |
| Provider Name | Daniel O Moegi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508534751 PECOS PAC ID: 2264821610 Enrollment ID: I20211105001387 |
| Provider Name | Hulda M Mosiori |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528673779 PECOS PAC ID: 0749670644 Enrollment ID: I20211208002767 |
| Provider Name | Brooke Resch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710507934 PECOS PAC ID: 5193142784 Enrollment ID: I20230616000902 |
| Provider Name | Luke Knutson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376759464 PECOS PAC ID: 4082069620 Enrollment ID: I20231218004118 |
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