| Minnesota Adult & Teen Challenge | |
|
3231 1st Ave S Minneapolis MN 55408-4407 | |
| (612) 373-3366 | |
| Not Available |
| Full Name | Minnesota Adult & Teen Challenge |
|---|---|
| Speciality | Clinic/Center |
| Location | 3231 1st Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Sadie Twite (REVENUE CYCLE DIRECTOR) |
| Authorized Official Contact | 6123733366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Minnesota Adult & Teen Challenge 740 E 24th St Minneapolis MN 55404 Ph: (612) 373-3366 | Minnesota Adult & Teen Challenge 3231 1st Ave S Minneapolis MN 55408-4407 Ph: (612) 373-3366 |
| NPI Number | 1831574797 |
|---|---|
| Provider Enumeration Date | 07/21/2015 |
| Last Update Date | 03/02/2023 |
| Certification Date | 03/02/2023 |
| Medicare PECOS PAC ID | 0840656856 |
|---|---|
| Medicare Enrollment ID | O20230517002547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831574797 | NPI | - | NPPES |
| Provider Name | Cynthia A Barsness |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518972009 PECOS PAC ID: 4385605120 Enrollment ID: I20041025000497 |
| Provider Name | Laurie Lee Breidel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811507841 PECOS PAC ID: 1052761418 Enrollment ID: I20231227001479 |
| Provider Name | Anna E Ramos |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588994313 PECOS PAC ID: 4981054103 Enrollment ID: I20231229000406 |
| Provider Name | Joseph Lee Malhoit |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942077821 PECOS PAC ID: 2264882406 Enrollment ID: I20231229001163 |
| Provider Name | Autumn Terlouw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083062459 PECOS PAC ID: 6507203429 Enrollment ID: I20240327000437 |
| Provider Name | Kirsten M Buzzell |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1730931098 PECOS PAC ID: 1759722739 Enrollment ID: I20240508000816 |
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