| Joel Grostephan, Licsw, Llc | |
|
3011 36th Ave S Ste 10 Minneapolis MN 55406-2800 | |
| (612) 839-5853 | |
| Not Available |
| Full Name | Joel Grostephan, Licsw, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3011 36th Ave S Ste 10, Minneapolis, Minnesota |
| Authorized Official Name and Position | Joel Paul Grostephan (THERAPIST/OWNER) |
| Authorized Official Contact | 6128395853 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joel Grostephan, Licsw, Llc 3011 36th Ave. S., #10 Minneapolis MN 55406 Ph: (612) 839-5853 | Joel Grostephan, Licsw, Llc 3011 36th Ave S Ste 10 Minneapolis MN 55406-2800 Ph: (612) 839-5853 |
| NPI Number | 1730559584 |
|---|---|
| Provider Enumeration Date | 10/05/2015 |
| Last Update Date | 10/05/2015 |
| Medicare PECOS PAC ID | 2769748532 |
|---|---|
| Medicare Enrollment ID | O20171110000935 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730559584 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 20930 (Minnesota) | Primary |
| Provider Name | Joel P Grostephan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326387051 PECOS PAC ID: 2062632110 Enrollment ID: I20141013001695 |
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