| Itasca Psychiatric Services Inc | |
|
25 Ne 3rd St Grand Rapids MN 55744-2742 | |
| (218) 327-2284 | |
| (218) 327-3173 |
| Full Name | Itasca Psychiatric Services Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 25 Ne 3rd St, Grand Rapids, Minnesota |
| Authorized Official Name and Position | David Bransford (CEO) |
| Authorized Official Contact | 2183272284 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Itasca Psychiatric Services Inc 25 Ne 3rd St Grand Rapids MN 55744-2742 Ph: (218) 327-2284 | Itasca Psychiatric Services Inc 25 Ne 3rd St Grand Rapids MN 55744-2742 Ph: (218) 327-2284 |
| NPI Number | 1083646327 |
|---|---|
| Provider Enumeration Date | 07/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083646327 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 23479 (Minnesota) | Primary |
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