| Primary Behavioral Health Clinic, Inc. | |
|
3433 Broadway St Ne Ste 160 Minneapolis MN 55413-1756 | |
| (612) 378-2363 | |
| (612) 378-2215 |
| Full Name | Primary Behavioral Health Clinic, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 3433 Broadway St Ne Ste 160, Minneapolis, Minnesota |
| Authorized Official Name and Position | Carole Sax (MANAGER) |
| Authorized Official Contact | 6123782363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Behavioral Health Clinic, Inc. 3433 Broadway St Ne Ste 160 Minneapolis MN 55413-1756 Ph: (612) 378-2363 | Primary Behavioral Health Clinic, Inc. 3433 Broadway St Ne Ste 160 Minneapolis MN 55413-1756 Ph: (612) 378-2363 |
| NPI Number | 1639254840 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 05/05/2008 |
| Medicare PECOS PAC ID | 7315023926 |
|---|---|
| Medicare Enrollment ID | O20080324000499 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639254840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | John P Cronin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164507448 PECOS PAC ID: 8628154234 Enrollment ID: I20080324000478 |
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