INNOVATIVE PSYCHOLOGICAL CONSULTANTS LLC NPI 1942221080

NPI Information

  • NPI: 1942221080
  • Provider Name: INNOVATIVE PSYCHOLOGICAL CONSULTANTS, LLC
  • Classification: Psychologist - 103TA0400X
  • Specialization: Addiction (Substance Use Disorder)
  • Entity Type: Organization
  • Address: 7372 KIRKWOOD CT
    MAPLE GROVE, MN
    ZIP 55369
  • Phone: (763) 416-4167

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NPI Details

INNOVATIVE PSYCHOLOGICAL CONSULTANTS, LLC is an addiction (substance use disorder) psychologist in Maple Grove, MN. The provider is a psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior. INNOVATIVE PSYCHOLOGICAL CONSULTANTS, LLC NPI is 1942221080. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

7372 KIRKWOOD CT
MAPLE GROVE, MN
ZIP 55369-202
Phone: (763) 416-4167
Fax: (763) 416-4137

The provider's authorized official is Christian Todd Anderson .
The authorized official title is Ceo and has the following contact phone number (763) 416-4167.

The enumeration date for this NPI number is 7/22/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TA0400XPsychologistAddiction (Substance Use Disorder)LP4615MINNESOTAYes
2103TC1900XPsychologistCounselingLP4615MINNESOTAX

What is NPI?

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This page was last updated on: 3/30/2025

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