| Legacy Mental Health Center | |
|
6550 York Ave. S. Suite 503 Edina MN 55435 | |
| (612) 801-3316 | |
| Not Available |
| Full Name | Legacy Mental Health Center |
|---|---|
| Speciality | Psychologist |
| Location | 6550 York Ave. S., Edina, Minnesota |
| Authorized Official Name and Position | Mary Mullenbach (PRESIDENT) |
| Authorized Official Contact | 6128013316 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Mental Health Center 6550 York Ave. S. Suite 503 Edina MN 55435-2336 Ph: () - | Legacy Mental Health Center 6550 York Ave. S. Suite 503 Edina MN 55435 Ph: (612) 801-3316 |
| NPI Number | 1801182837 |
|---|---|
| Provider Enumeration Date | 06/28/2011 |
| Last Update Date | 08/23/2018 |
| Medicare PECOS PAC ID | 5799950283 |
|---|---|
| Medicare Enrollment ID | O20111212000760 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801182837 | NPI | - | NPPES |
| 1801192937 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 4360 (Minnesota) | Primary |
| Provider Name | Mary A Mullenbach |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235351826 PECOS PAC ID: 7810893690 Enrollment ID: I20031211000491 |
| Provider Name | Thomas E Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255431003 PECOS PAC ID: 3072554427 Enrollment ID: I20050517000248 |
| Provider Name | Rachel B Fate |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912341553 PECOS PAC ID: 0547400913 Enrollment ID: I20130708000352 |
| Provider Name | Justin D Jeffrey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942670039 PECOS PAC ID: 3577867035 Enrollment ID: I20160204000547 |
| Provider Name | Nancy Joseph-goldfarb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417400870 PECOS PAC ID: 2961780960 Enrollment ID: I20161026001100 |
| Provider Name | James D Gitar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639351844 PECOS PAC ID: 3173802568 Enrollment ID: I20161107001541 |
| Provider Name | Paige E Sorenson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144702374 PECOS PAC ID: 8426300757 Enrollment ID: I20181015000820 |
| Provider Name | Marjorie R Keyes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972869527 PECOS PAC ID: 2860775566 Enrollment ID: I20200220003058 |
| Provider Name | Anna K Heinzerling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568800886 PECOS PAC ID: 3577983204 Enrollment ID: I20201020000591 |
| Provider Name | Emily B Lewandowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972230084 PECOS PAC ID: 8820473176 Enrollment ID: I20220922001292 |
| Provider Name | Kristen E Orazem |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346599586 PECOS PAC ID: 3072982933 Enrollment ID: I20221215001618 |
| Provider Name | Jennifer E Egeland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083131197 PECOS PAC ID: 5698144467 Enrollment ID: I20221219000314 |
| Provider Name | Maggie J Katzenmaier Ragone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366158404 PECOS PAC ID: 6901249572 Enrollment ID: I20240210000649 |
| Provider Name | Sarah C Weber |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1265836597 PECOS PAC ID: 7517302409 Enrollment ID: I20240301001368 |
| Provider Name | Megan M Ruane |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881206761 PECOS PAC ID: 1850737297 Enrollment ID: I20240307004132 |
| Provider Name | Lisa M Rutford |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821658253 PECOS PAC ID: 1850737024 Enrollment ID: I20240311000638 |
| Provider Name | Lauren A Callis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740062066 PECOS PAC ID: 8224475132 Enrollment ID: I20240327000067 |
| Provider Name | Marne L Chaput |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033620935 PECOS PAC ID: 3577904259 Enrollment ID: I20240513001336 |
Laski Mental Wellness & Counseling, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 7101 York Ave S Ste 145, Edina, MN 55435 Phone: 612-202-0535 Fax: 763-999-6107 | |
Evolving Woman Enterprises, Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 7300 Metro Blvd, Suite 455, Edina, MN 55439 Phone: 952-835-1616 Fax: 952-835-6182 | |
Angela Brust, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 5200 Willson Rd Ste 307, Edina, MN 55424 Phone: 612-987-8070 | |
Mooney Consulting Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 7200 France Ave S, Suite 224, Edina, MN 55435 Phone: 952-831-0422 Fax: 952-831-0443 | |
Thrive Modern Health P.a. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 7101 York Ave S Ste 157, Edina, MN 55435 Phone: 612-254-6414 | |
Heartland Health Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6950 France Ave S Ste 14, Edina, MN 55435 Phone: 952-922-9056 | |
Johnson Counseling Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 7200 France Ave S Ste 224, Edina, MN 55435 Phone: 612-205-7989 |