| Clearwaters Crosby Llc | |
|
207 1st St Nw Crosby MN 56441-1301 | |
| (218) 585-2052 | |
| Not Available |
| Full Name | Clearwaters Crosby Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 207 1st St Nw, Crosby, Minnesota |
| Authorized Official Name and Position | Tanya Kubista (OWNER) |
| Authorized Official Contact | 2185852052 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clearwaters Crosby Llc 15157 Ladyslipper Ln Deerwood MN 56444-8918 Ph: (218) 585-2058 | Clearwaters Crosby Llc 207 1st St Nw Crosby MN 56441-1301 Ph: (218) 585-2052 |
| NPI Number | 1093389736 |
|---|---|
| Provider Enumeration Date | 05/17/2021 |
| Last Update Date | 09/28/2024 |
| Certification Date | 09/28/2024 |
| Medicare PECOS PAC ID | 2769827435 |
|---|---|
| Medicare Enrollment ID | O20240304003263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093389736 | NPI | - | NPPES |
| 1154711406 | Medicaid | MN | |
| 1093389736 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Tanya Martha Kubista |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1154711406 PECOS PAC ID: 4587009253 Enrollment ID: I20240304003334 |
Northernwaters Counseling Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 207 1st St Nw, Crosby, MN 56441 Phone: 218-296-0632 | |
Planting Seeds Learning Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 W Main St Ste B, Crosby, MN 56441 Phone: 218-353-5472 |