DR. DUSTIN BROCKBERG (NPI# 1801422928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801422928 |
| Entity Type | Individual |
| Full Name | DR. DUSTIN BROCKBERG |
| Credential | PHD |
| Practice Address |
15251 Pleasant Valley Rd Center City MN 55012-9640 |
| Mailing Address |
2713 88th Ave Ne Blaine MN 55449-6748 |
| Practice Telephone | 6512134078 |
| Mailing Telephone | 9524127875 |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2020-09-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | LP6577 | MN | Behavioral Health & Social Service Providers |
| Street Address |
15251 PLEASANT VALLEY RD |
| City | CENTER CITY |
| State | MN |
| Zip Code | 55012-9640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134195506 | Kathryn M Manning | Psychiatry & Neurology | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2006-02-27 |
| 1730792664 | Amy Vetter | Nurse Practitioner | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2020-08-29 |
| 1740899756 | Stacie Bistodeau | Nurse Practitioner | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2020-07-26 |
| 1538791694 | Darcey R Copeland | Counselor | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2020-02-06 |
| 1639701782 | Alisha Dybedahl | Counselor | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2020-02-06 |
| 1225669963 | Janesa Marie Hupke | Counselor | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2020-01-31 |
| 1588295349 | Chantelle Nicole Bordelon | Counselor | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2020-01-30 |
| 1447881214 | Randa N Tchelebi | Counselor | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2020-01-30 |
| 1437623477 | Angela Rempelewert | Counselor | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2019-01-13 |
| 1295194819 | Recovery Partners, PC At Center City | Psychologist | 15251 Pleasant Valley Rd, Center City, MN 55012-9640 | 2016-02-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902026131 | Gordon R Dodge | Psychologist | 204 Summit Ave, Center City, MN 55012 | 2007-04-30 |
| 1871668384 | Jessica Amy Pierzina | Psychologist | W20298 State Rd. 121, Whitehall, WI 55012 | 2006-11-21 |
| 1972782290 | Gordy's Pharmacy Inc. | Pharmacy | 320 Summit Ave, Center City, MN 55012 | 2007-11-02 |
| 1568529261 | Hazelden Foundation | Substance Abuse Rehabilitation Facility | 15423 Pleasant Valley Rd., Center City, MN 55012-0011 | 2007-01-02 |
| 1013949965 | William F Garrison | Pharmacist | 320 Summit Ave, Center City, MN 55012-0127 | 2006-07-07 |
| 1962506329 | Jeffrey Earl Rivard | Dentist | 420 Grand Ave., Center City, MN 55012-0235 | 2006-09-07 |
| 1487002960 | Tyler Jensen | Dentist | 420 Grand Ave, Center City, MN 55012-3553 | 2016-05-25 |
| 1871954651 | Center Lake Dental, Pa | Clinic/Center | 420 Grand Ave, Center City, MN 55012-3553 | 2016-03-08 |
| 1659408904 | Chisago County Human Services | Public Health or Welfare | 313 N Main St, Rm 239, Center City, MN 55012-7698 | 2007-02-27 |
| 1679767016 | Kent David Smallwood | Psychologist | 15251 Pleasant Valley Rd # Co7, Center City, MN 55012-9640 | 2007-08-29 |
| Find all providers in zip 55012 | ||||
| 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 |
|---|---|---|---|---|
| 1902026131 | Gordon R Dodge | Psychologist | 204 Summit Ave, Center City, MN 55012 | 2007-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493952 | Michelle Brownfield | Psychologist | 606 Spear Ave, Duluth, MN 55803-2154 | 2020-10-01 |
| 1730716994 | Tamolyn Patterson Benke | Psychologist | 8453 Casey Ct, Inver Grove Heights, MN 55076-5154 | 2020-03-26 |
| 1407496516 | Liza N Meredith | Psychologist | Acacia Counseling and Wellness, 2724 University Ave Se Unit B, Minneapolis, MN 55414 | 2020-01-07 |
| 1134764871 | Avital Ogniewicz | Psychologist | 2519 Commerce Dr Nw, Rochester, MN 55901-4432 | 2019-11-15 |
| 1164065868 | Karen Nicole Chinnock | Psychologist | 930 Blue Gentian Rd, Eagan, MN 55121-1674 | 2019-10-25 |
| 1194368191 | Luz Angelica Fehn Salinas | Psychologist | 1315 E24th St, Minneapolis, MN 55404 | 2019-10-22 |
| 1083257349 | Nathaniel Page | Psychologist | 2423 Valley Dr, Northfield, MN 55057-3224 | 2019-10-18 |
| 1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
| 1164071148 | Amy C Moran | Psychologist | Acacia Counseling & Wellness, 2724 University Ave., Unit B, Minneapolis, MN 55414 | 2019-09-11 |
| 1881243590 | Bill Clafton Psyd Lp LLC | Psychologist | 1755 Old West Main St Ste 204, Red Wing, MN 55066-3057 | 2019-09-05 |
| Find all providers with the same taxonomy | ||||
| City | CENTER CITY |
| Zip Code | 55012 |
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| 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.