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900 Old Farm Rd Mora MN 55051-4412 | |
| (320) 679-2438 | |
| (320) 679-6906 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 900 Old Farm Rd, Mora, Minnesota |
| Authorized Official Name and Position | Mark Stegeman (OWNER) |
| Authorized Official Contact | 6514971021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
900 Old Farm Rd Mora MN 55051-4412 Ph: (320) 679-2438 | 900 Old Farm Rd Mora MN 55051-4412 Ph: (320) 679-2438 |
| NPI Number | 1548666985 |
|---|---|
| Provider Enumeration Date | 11/12/2014 |
| Last Update Date | 05/15/2024 |
| Medicare PECOS PAC ID | 9537606967 |
|---|---|
| Medicare Enrollment ID | O20240802003713 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548666985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2524 (Minnesota) | Primary |
| Provider Name | Mark D Stegeman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376973859 PECOS PAC ID: 3072050400 Enrollment ID: I20240802003764 |
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