| Lakeside Mental Health | |
|
2330 Troop Dr Unit 101 Sartell MN 56377-4531 | |
| (320) 296-1592 | |
| (320) 640-3029 |
| Full Name | Lakeside Mental Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 2330 Troop Dr Unit 101, Sartell, Minnesota |
| Authorized Official Name and Position | Kati Klitzke (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 3206402980 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Mental Health 65506 210th St Litchfield MN 55355-5744 Ph: (320) 640-2980 | Lakeside Mental Health 2330 Troop Dr Unit 101 Sartell MN 56377-4531 Ph: (320) 296-1592 |
| NPI Number | 1457011371 |
|---|---|
| Provider Enumeration Date | 12/20/2021 |
| Last Update Date | 01/25/2022 |
| Certification Date | 01/25/2022 |
| Medicare PECOS PAC ID | 1153770227 |
|---|---|
| Medicare Enrollment ID | O20231214001818 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457011371 | NPI | - | NPPES |
| 1750746715 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kati J Klitzke |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750746715 PECOS PAC ID: 7012218548 Enrollment ID: I20151229000102 |
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