| Five Rivers Mental Health Clinic Llc | |
|
1650 Madison Ave Ste 102 Mankato MN 56001-5471 | |
| (507) 345-7012 | |
| (507) 388-6937 |
| Full Name | Five Rivers Mental Health Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1650 Madison Ave, Mankato, Minnesota |
| Authorized Official Name and Position | Sarah K Sifers (PRESIDENT) |
| Authorized Official Contact | 5073457012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Five Rivers Mental Health Clinic Llc 1650 Madison Ave Ste 102 Mankato MN 56001-5471 Ph: (507) 345-7012 | Five Rivers Mental Health Clinic Llc 1650 Madison Ave Ste 102 Mankato MN 56001-5471 Ph: (507) 345-7012 |
| NPI Number | 1689111601 |
|---|---|
| Provider Enumeration Date | 01/28/2017 |
| Last Update Date | 08/19/2020 |
| Certification Date | 08/19/2020 |
| Medicare PECOS PAC ID | 5698042729 |
|---|---|
| Medicare Enrollment ID | O20170522001033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689111601 | NPI | - | NPPES |
| 1689111601 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | LP5185 (Minnesota) | Primary |
| Provider Name | Sarah K Sifers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659656031 PECOS PAC ID: 6406147008 Enrollment ID: I20160628002216 |
| Provider Name | Gudrun Teigen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548700859 PECOS PAC ID: 9931484581 Enrollment ID: I20170321002507 |
| Provider Name | Kristy Jean Danielson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396417705 PECOS PAC ID: 2163811902 Enrollment ID: I20211116001815 |
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