| Asc Psychological Services | |
|
11 Civic Center Plz Ste 205 Mankato MN 56001-7718 | |
| (507) 345-4679 | |
| (507) 345-8685 |
| Full Name | Asc Psychological Services |
|---|---|
| Speciality | Psychologist |
| Location | 11 Civic Center Plz Ste 205, Mankato, Minnesota |
| Authorized Official Name and Position | George Komaridis (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 5073454679 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Asc Psychological Services 11 Civic Center Plz Ste 205 Mankato MN 56001-7718 Ph: (507) 345-4679 | Asc Psychological Services 11 Civic Center Plz Ste 205 Mankato MN 56001-7718 Ph: (507) 345-4679 |
| NPI Number | 1376820118 |
|---|---|
| Provider Enumeration Date | 11/08/2011 |
| Last Update Date | 11/29/2023 |
| Certification Date | 11/29/2023 |
| Medicare PECOS PAC ID | 3476790296 |
|---|---|
| Medicare Enrollment ID | O20130515000172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376820118 | NPI | - | NPPES |
| Provider Name | George V Komaridis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124297213 PECOS PAC ID: 7719124544 Enrollment ID: I20130515000189 |
| Provider Name | Kayleen Rae Vieburg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417668153 PECOS PAC ID: 9133593882 Enrollment ID: I20230320000869 |
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