| Plymouth Psych Group, Llc | |
|
3021 Harbor Ln N Suite 206 Plymouth MN 55447-5109 | |
| (651) 271-9005 | |
| (763) 271-2707 |
| Full Name | Plymouth Psych Group, Llc |
|---|---|
| Speciality | Counselor |
| Location | 3021 Harbor Ln N, Plymouth, Minnesota |
| Authorized Official Name and Position | Israel Sokeye (OWNER) |
| Authorized Official Contact | 6512719005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Plymouth Psych Group, Llc 3021 Harbor Ln N Suite 206 Plymouth MN 55447-5109 Ph: (651) 271-9005 | Plymouth Psych Group, Llc 3021 Harbor Ln N Suite 206 Plymouth MN 55447-5109 Ph: (651) 271-9005 |
| NPI Number | 1003195942 |
|---|---|
| Provider Enumeration Date | 08/10/2011 |
| Last Update Date | 08/10/2011 |
| Medicare PECOS PAC ID | 6800103490 |
|---|---|
| Medicare Enrollment ID | O20150915000728 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003195942 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Joan Marie Gibson |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1518916071 PECOS PAC ID: 7719959790 Enrollment ID: I20040810000979 |
| Provider Name | Deann L Reese |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457363632 PECOS PAC ID: 3678527710 Enrollment ID: I20050310000858 |
| Provider Name | Israel O Sokeye |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548428808 PECOS PAC ID: 1759419708 Enrollment ID: I20100601000540 |
| Provider Name | Heidi L Arnold |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346395878 PECOS PAC ID: 4183819501 Enrollment ID: I20101111000515 |
| Provider Name | Gerard Balan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518108455 PECOS PAC ID: 1759430937 Enrollment ID: I20111021000316 |
| Provider Name | Abimbola Olajumoke Osagie |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457516734 PECOS PAC ID: 9133294127 Enrollment ID: I20120327000499 |
| Provider Name | Elizabeth L Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487998977 PECOS PAC ID: 3779708664 Enrollment ID: I20140709001455 |
| Provider Name | Jamie L Giles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396100046 PECOS PAC ID: 2264737998 Enrollment ID: I20160218000078 |
| Provider Name | Brittan J Donohoe |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1538531165 PECOS PAC ID: 0648578328 Enrollment ID: I20160413000590 |
| Provider Name | Merryssa L Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215579461 PECOS PAC ID: 5991137739 Enrollment ID: I20191115000593 |
| Provider Name | Victoria S Hadley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255976387 PECOS PAC ID: 0345674065 Enrollment ID: I20200103002270 |
| Provider Name | Afolake A Adewumi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790320372 PECOS PAC ID: 1052741444 Enrollment ID: I20200427001612 |
| Provider Name | John I Nwabugwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215530571 PECOS PAC ID: 0042624702 Enrollment ID: I20210121000517 |
| Provider Name | Elaina F Railey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689292369 PECOS PAC ID: 9032526918 Enrollment ID: I20210319000876 |
| Provider Name | Ekan J Ekong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770239758 PECOS PAC ID: 7012396955 Enrollment ID: I20220623000040 |
| Provider Name | Mason R Nordman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679235899 PECOS PAC ID: 0648643775 Enrollment ID: I20230310000266 |
| Provider Name | Titilope Olaoluwa Omisakin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407536345 PECOS PAC ID: 6901252857 Enrollment ID: I20231027003126 |
| Provider Name | Andrew Carson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1124624614 PECOS PAC ID: 7214475458 Enrollment ID: I20240819002581 |
| Provider Name | Amanda Jean Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669104899 PECOS PAC ID: 9335689488 Enrollment ID: I20240904003377 |
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