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Deactivated NPI 1760469506 Deactivated / Inactive NPI Male Practitioner

Dr. Thomas Paul Carrillo , PhD, LP, PA

Psychologist - Counseling • Minneapolis, MN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Thomas Carrillo has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date December 22, 2005
NPI Deactivation Date August 08, 2017
Total Practice Duration ~12 Years of Practice (2005 – 2017)

Professional Overview & Biography Verified Profile Summary

Dr. Thomas Carrillo, PhD, LP, PA was a registered Psychologist - Counseling practicing in Minneapolis, MN. Throughout an active medical career spanning 12 years, Dr. Carrillo provided care at the practice location at 3100 W LAKE ST until profile deactivation on 2017-08-08.

Practice Location & Contact Primary Location

Practice Address

3100 W Lake St
Suite 460

Minneapolis, MN 554164527

Telephone 6129290114
Fax 6129290116
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist - Counseling in Minneapolis, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 19.5 Yrs
State Avg: 24.4 Yrs
Regional Practice Density
82 Specialists

Practicing in Minneapolis, MN (419 Statewide)

Telehealth Adoption Rate
4.9% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Psychologist - Counseling Primary Specialty

NUCC Taxonomy Code: 103TC1900X

State License MN LP0339

A psychologist who specializes in general practice and health service. It focuses on how people function both personally and in their relationships at all ages. Counseling psychology addresses the emotional, social, work, school and physical health concerns people may have at different stages in their lives, focusing on typical life stresses and more severe issues with which people may struggle as individuals and as a part of families, groups and organizations. Counseling psychologists help people with physical, emotional and mental health issues improve their sense of well-being, alleviate feelings of distress and resolve crises. They also provide assessment, diagnosis, and treatment of more severe psychological symptoms.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
James Moore , LP

Psychologist - Clinical

NPI 1033286489

Licensed Psychologist

Diane Jaskoviak , LP

Psychologist - Clinical

NPI 1053487173

Licensed Psychologist

Gara Swenson , LP

Psychologist - Clinical

NPI 1063580538

Licensed Psychologist

Marlene Mcewan , LP

Psychologist - Clinical

NPI 1063589489

Licensed Psychologist

Gregg Riley , LP

Psychologist - Clinical

NPI 1073681649

Licensed Psychologist

Bruce Stewart , LP

Psychologist - Clinical

NPI 1104970045

Licensed Psychologist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated August 08, 2017

Record deactivated on August 08, 2017

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 3100 W LAKE ST, SUITE 460, MINNEAPOLIS, MN 554164527 (Tel: 6129290114)

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Updated Business Mailing Address July 08, 2007

Registered at 1135 CEDAR VIEW CIR, MINNEAPOLIS, MN 554052106 (Tel: 6123778591)

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Provider Name / Credentials Updated July 08, 2007

Recorded as THOMAS CARRILLO, PH.D.,L.P., P.A.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Psychologist (License #LP0339 in MN)

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Initial NPI Registration & Enumeration December 22, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1760469506
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 22, 2005
Last Update: July 08, 2007
Deactivation Date: August 08, 2017

Mailing Address

1135 Cedar View Cir

Minneapolis, MN 554052106

Phone: 6123778591

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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