Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Brian J Gatheridge, PHD

Individual provider Clinical Child & Adolescent Psychologist · NPI 1043465644

Brian J Gatheridge, PHD is a Clinical Psychologist in Detroit Lakes, Minnesota. Qualified in 2007, 19 years ago. Practices with Sanford Medical Center Fargo, a 1,212-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
19
Licensed in
MN
In the registry since
2008
Specialties on file
2
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

See every abbreviation used in this directory →

Practice location Address checks out

1245 Washington Ave
Detroit Lakes, MN 56501-3905
Phone: (218) 846-2000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X · Licence LP4970 (MN)
Clinical Child & Adolescent Psychologist Taxonomy 103TC2200X

Record details

NPI number1043465644
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorNo
NPI enumeratedNovember 24, 2008
Last updated in NPPESApril 4, 2022
Certification dateApril 4, 2022
Mailing address1219 S. Washington Ave, Detroit Lakes, MN 56501-3905

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Sanford Medical Center Fargo — 1212 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare