| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 210 20th St S, New Ulm, Minnesota |
| Authorized Official Name and Position | Christopher Brys Davis (OWNER/THERAPIST) |
| Authorized Official Contact | 5077667685 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 743 New Ulm MN 56073-2223 Ph: (507) 766-7685 | 210 20th St S New Ulm MN 56073 Ph: (507) 766-7685 |
| NPI Number | 1952841413 |
|---|---|
| Provider Enumeration Date | 03/03/2017 |
| Last Update Date | 02/23/2023 |
| Certification Date | 02/23/2023 |
| Medicare PECOS PAC ID | 5799220232 |
|---|---|
| Medicare Enrollment ID | O20240709003577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952841413 | NPI | - | NPPES |
| 802944000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 17460 (Minnesota) | Primary |
| Provider Name | Christopher B Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184738882 PECOS PAC ID: 5496643223 Enrollment ID: I20051021000176 |
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