| Charme S. Davidson, Llc | |
|
211 N 1st St Ste 285 Minneapolis MN 55401-1480 | |
| (612) 870-0510 | |
| Not Available |
| Full Name | Charme S. Davidson, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 211 N 1st St Ste 285, Minneapolis, Minnesota |
| Authorized Official Name and Position | Charme S. S. Davidson (SOLE OWNER/SOLE MEMBER) |
| Authorized Official Contact | 6128700510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charme S. Davidson, Llc 211 N 1st St Ste 285 Minneapolis MN 55401-1480 Ph: (612) 870-0510 | Charme S. Davidson, Llc 211 N 1st St Ste 285 Minneapolis MN 55401-1480 Ph: (612) 870-0510 |
| NPI Number | 1588748982 |
|---|---|
| Provider Enumeration Date | 10/24/2006 |
| Last Update Date | 07/07/2021 |
| Certification Date | 07/07/2021 |
| Medicare PECOS PAC ID | 7517966096 |
|---|---|
| Medicare Enrollment ID | O20061211000334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588748982 | NPI | - | NPPES |
| 1285687889 | Other | MN | INDIVIDUAL NPI |
| 627547800 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP2642 (Minnesota) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Charme S Davidson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285687889 PECOS PAC ID: 9931106648 Enrollment ID: I20061023000028 |
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