| Bewell Psychotherapy Pllc | |
|
1821 University Ave W Ste 461-9 Saint Paul MN 55104-2801 | |
| (612) 421-3178 | |
| (612) 421-3183 |
| Full Name | Bewell Psychotherapy Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 1821 University Ave W Ste 461-9, Saint Paul, Minnesota |
| Authorized Official Name and Position | Ross Elliot Gubrud (MD OWNER) |
| Authorized Official Contact | 6124213187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bewell Psychotherapy Pllc 3501 Xenium Ln N Apt 123 Minneapolis MN 55441-2222 Ph: (612) 421-3187 | Bewell Psychotherapy Pllc 1821 University Ave W Ste 461-9 Saint Paul MN 55104-2801 Ph: (612) 421-3178 |
| NPI Number | 1346819307 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 11/03/2021 |
| Certification Date | 10/27/2021 |
| Medicare PECOS PAC ID | 9638561947 |
|---|---|
| Medicare Enrollment ID | O20220119000541 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346819307 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Ross E Gubrud |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1285166355 PECOS PAC ID: 1456743764 Enrollment ID: I20220119000819 |
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