BRENDA LYNN DESTACHE (NPI# 1518132737) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518132737 |
| Entity Type | Individual |
| Full Name | BRENDA LYNN DESTACHE |
| Credential | MSLP |
| Practice Address |
1976 Woodale Dr Woodbury MN 55125 |
| Mailing Address |
391 Jesse James Ln Mahtomedi MN 55115-1794 |
| Practice Telephone | 6517308464 |
| Mailing Telephone | 6517308464 |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | LP2836 | MN | Behavioral Health & Social Service Providers |
| Street Address |
1976 WOODALE DR |
| City | WOODBURY |
| State | MN |
| Zip Code | 55125 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487268728 | Haley Kirkpatrick | Behavior Technician | 721 Commerce Dr., Woodbury, MN 55125 | 2020-09-03 |
| 1689218091 | Jordan Schmidt | Student in an Organized Health Care Education/Training Program | 1740 Welr Dr. #24, Woodbury, MN 55125 | 2019-10-30 |
| 1629619580 | Mackenzie Ann Funke | Occupational Therapist | 721 Commerce Drivve, Woodbury, MN 55125 | 2019-10-02 |
| 1700342029 | Darcy Stivland | Counselor | 1811 Weir Drive #270, Woodbury, MN 55125 | 2019-02-11 |
| 1235609884 | Elizabeth Kennedy Ward | Psychologist | 7582 Currell Blvd Suite 208, Woodbury, MN 55125 | 2018-11-27 |
| 1528573664 | Cory Lee Baumeister | Counselor | 652 Bielenberg Dr, Woodbury, MN 55125 | 2017-12-12 |
| 1760918239 | David James Knight | Dentist | 9950 Valley Creek Rd Ste 150, Woodbury, MN 55125 | 2017-05-03 |
| 1366988826 | Mark Your Home Health Care LLC | Home Health | 6053 Hudson Road, Suite 200, Woodbury, MN 55125 | 2017-01-09 |
| 1518415736 | Kubei Holdings Group LLC | Case Management | 6043 Hudson Rd Ste 340, Saint Paul, MN 55125 | 2016-09-16 |
| 1285087072 | Adrian Jung | Occupational Therapist | 155 Radio Drive, Woodbury, MN 55125 | 2016-07-18 |
| Find all providers in zip 55125 | ||||
| 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 |
|---|---|---|---|---|
| 1235609884 | Elizabeth Kennedy Ward | Psychologist | 7582 Currell Blvd Suite 208, Woodbury, MN 55125 | 2018-11-27 |
| 1073027587 | Victor Counseling and Consultant Services, LLC | Psychologist | 6043 Hudson Rd Ste 355, Woodbury, MN 55125-1017 | 2017-11-20 |
| 1720492671 | Stephanie Milz | Psychologist | 721 Commerce Drive, Woodbury, MN 55125 | 2014-06-19 |
| 1790015568 | Laura Elizabeth Accomando | Psychologist | 6043 Hudson Rd Ste 290, Woodbury, MN 55125-1002 | 2009-12-30 |
| 1437488475 | Beth M Lutz | Psychologist | 7616 Currell Blvd Ste 190, Woodbury, MN 55125-8202 | 2009-12-22 |
| 1780707059 | Ruth Cantor Mayer | Psychologist | 1080 Main St S, Suite 5, Woodbury, CT 06798-3810 | 2007-04-09 |
| 1477612992 | Stuart Pace | Psychologist | 35 Fairbanks Blvd, Woodbury, NY 11797-2603 | 2006-12-08 |
| 1215001136 | Therese Kohs Gilbertson | Psychologist | 2150 Radio Dr, Woodbury, MN 55125-9453 | 2006-11-20 |
| 1093804338 | Kathlyn Elvera Nelson | Psychologist | 7616 Currell Blvd Ste 280, Woodbury, MN 55125-2296 | 2006-10-12 |
| 1477651107 | Juliane R Capone | Psychologist | 6 Meadow Ridge Ct, Woodbury, NY 11797 | 2006-09-20 |
| Find all providers in WOODBURY | ||||
Please comment or provide details below to improve the information on BRENDA LYNN DESTACHE.
| 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.