| Momenta Mental Health | |
|
2179 4th St Ste 2f White Bear Lake MN 55110-3041 | |
| (701) 426-8833 | |
| Not Available |
| Full Name | Momenta Mental Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 2179 4th St Ste 2f, White Bear Lake, Minnesota |
| Authorized Official Name and Position | Brianne M Marion (OWNER) |
| Authorized Official Contact | 6513816611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Momenta Mental Health 1060 Hillvale Ave N Oakdale MN 55128-5859 Ph: (651) 381-6611 | Momenta Mental Health 2179 4th St Ste 2f White Bear Lake MN 55110-3041 Ph: (701) 426-8833 |
| NPI Number | 1215692785 |
|---|---|
| Provider Enumeration Date | 11/01/2021 |
| Last Update Date | 01/13/2022 |
| Certification Date | 01/13/2022 |
| Medicare PECOS PAC ID | 4082000120 |
|---|---|
| Medicare Enrollment ID | O20220330000047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215692785 | NPI | - | NPPES |
| 1053785691 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Brianne Marion |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053785691 PECOS PAC ID: 5395048847 Enrollment ID: I20200519000042 |
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