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7766 Highway 65 Ne Spring Lake Park MN 55432-2832 | |
| (612) 296-0317 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 7766 Highway 65 Ne, Spring Lake Park, Minnesota |
| Authorized Official Name and Position | Paula Louise Brandt (PRESIDENT) |
| Authorized Official Contact | 6122960317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7766 Highway 65 Ne Spring Lake Park MN 55432-2832 Ph: (612) 296-0317 | 7766 Highway 65 Ne Spring Lake Park MN 55432-2832 Ph: (612) 296-0317 |
| NPI Number | 1528726775 |
|---|---|
| Provider Enumeration Date | 12/06/2021 |
| Last Update Date | 05/10/2023 |
| Certification Date | 05/10/2023 |
| Medicare PECOS PAC ID | 3779940937 |
|---|---|
| Medicare Enrollment ID | O20230601002840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528726775 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Bruce H Field |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023084076 PECOS PAC ID: 7517092042 Enrollment ID: I20100322000958 |
| Provider Name | Jill M Sweeny |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730200197 PECOS PAC ID: 4183018146 Enrollment ID: I20220308002496 |
| Provider Name | John Lichtsinn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063739266 PECOS PAC ID: 2365809381 Enrollment ID: I20230607001545 |
| Provider Name | Patricia Jean Dickmann |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215256334 PECOS PAC ID: 3870942352 Enrollment ID: I20231208002151 |
| Provider Name | Alexandra K Chapman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1801271101 PECOS PAC ID: 4880032705 Enrollment ID: I20240410002715 |
| Provider Name | Kyle William Ross |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528502598 PECOS PAC ID: 3375081086 Enrollment ID: I20240813002068 |
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