| North Psychology Clinic Pa | |
|
6120 Earle Brown Drive Ste. 520 North Psychology Clinic P.a. Brooklyn Center MN 55430-2123 | |
| (763) 531-0566 | |
| (763) 531-0602 |
| Full Name | North Psychology Clinic Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 6120 Earle Brown Drive Ste. 520, Brooklyn Center, Minnesota |
| Authorized Official Name and Position | Diane K. Felton (PRESIDENT) |
| Authorized Official Contact | 7635310566 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Psychology Clinic Pa 6120 Earle Brown Drive Ste. 520 North Psychology Clinic Pa Brooklyn Center MN 55430-2123 Ph: (763) 531-0566 | North Psychology Clinic Pa 6120 Earle Brown Drive Ste. 520 North Psychology Clinic P.a. Brooklyn Center MN 55430-2123 Ph: (763) 531-0566 |
| NPI Number | 1265462212 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 10/16/2024 |
| Certification Date | 10/16/2024 |
| Medicare PECOS PAC ID | 3870545668 |
|---|---|
| Medicare Enrollment ID | O20050221000501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265462212 | NPI | - | NPPES |
| 30786NO | Other | MN | BLUE CROSS BLUE SHIEL |
| 973518600 | Medicaid | MN | |
| 30787NO | Other | MN | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Minnesota) | Primary |
| Provider Name | Rochelle J Brandl |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750458899 PECOS PAC ID: 6002817020 Enrollment ID: I20070118000049 |
| Provider Name | Thomas A Breitenbucher |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699846154 PECOS PAC ID: 9638350465 Enrollment ID: I20110225000638 |
| Provider Name | Devon Elizabeth Whitehead |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003037458 PECOS PAC ID: 9335387216 Enrollment ID: I20130606000524 |
| Provider Name | Michelle R Mandell-paulson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912425158 PECOS PAC ID: 6608268677 Enrollment ID: I20220125001495 |
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