Provider Demographics
NPI:1902942667
Name:CONCEPCION PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:CONCEPCION PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-714-2000
Mailing Address - Street 1:6230 10TH ST N
Mailing Address - Street 2:SUITE 310-B
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6158
Mailing Address - Country:US
Mailing Address - Phone:651-714-2000
Mailing Address - Fax:651-714-4400
Practice Address - Street 1:6230 10TH ST N
Practice Address - Street 2:SUITE 310-B
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6158
Practice Address - Country:US
Practice Address - Phone:651-714-2000
Practice Address - Fax:651-714-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103577OtherHEALTH PARTNERS MN
MN453T3COOtherBLUE CROSS BLUE SHIELD MN
MN990991023407OtherPREFERRED ONE MN
MN6190337OtherUNITED BEHAVIORAL HLTH-MN