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400 S 2nd St Princeton MN 55371-1865 | |
| (612) 787-2212 | |
| (612) 448-0900 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 400 S 2nd St, Princeton, Minnesota |
| Authorized Official Name and Position | Karla R Carey (OWNER) |
| Authorized Official Contact | 6127872212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
26330 102nd St Nw Zimmerman MN 55398-8578 Ph: (763) 360-4260 | 400 S 2nd St Princeton MN 55371-1865 Ph: (612) 787-2212 |
| NPI Number | 1568033215 |
|---|---|
| Provider Enumeration Date | 07/05/2021 |
| Last Update Date | 07/05/2022 |
| Certification Date | 06/07/2022 |
| Medicare PECOS PAC ID | 7113361734 |
|---|---|
| Medicare Enrollment ID | O20240221004254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568033215 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Karla Carey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215596440 PECOS PAC ID: 7113384298 Enrollment ID: I20240221004280 |
| Provider Name | Barbara Lynn Wisniewski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609471697 PECOS PAC ID: 3173965175 Enrollment ID: I20240522001797 |
| Provider Name | Mary Beth Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972677979 PECOS PAC ID: 6800339441 Enrollment ID: I20240624001803 |
| Provider Name | Charlene Brouwer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1720513005 PECOS PAC ID: 5395289722 Enrollment ID: I20240626003864 |
| Provider Name | Amy Jo Spinner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851148555 PECOS PAC ID: 5496290769 Enrollment ID: I20240710004448 |
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