| Range Mental Health Center | |
|
624 S 13th St Virginia MN 55792 | |
| (218) 749-2881 | |
| (218) 749-3806 |
| Full Name | Range Mental Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 624 S 13th St, Virginia, Minnesota |
| Authorized Official Name and Position | Mary J Carpenter (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2187492881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Range Mental Health Center Po Box 1188 Virginia MN 55792-1188 Ph: (218) 749-2881 | Range Mental Health Center 624 S 13th St Virginia MN 55792 Ph: (218) 749-2881 |
| NPI Number | 1457452823 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 04/01/2016 |
| Medicare PECOS PAC ID | 3173434628 |
|---|---|
| Medicare Enrollment ID | O20040930000462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457452823 | NPI | - | NPPES |
| 104855400 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Heather J Roark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619048980 PECOS PAC ID: 1850446055 Enrollment ID: I20090910000575 |
| Provider Name | Annmarie K Florest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275890980 PECOS PAC ID: 3274799390 Enrollment ID: I20120718000173 |
| Provider Name | Jill M Barger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427480474 PECOS PAC ID: 9638306764 Enrollment ID: I20131218000319 |
| Provider Name | Tanya D Wozniak |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023150612 PECOS PAC ID: 6204991664 Enrollment ID: I20160706002527 |
| Provider Name | Sara D Rohr |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770723157 PECOS PAC ID: 6608929880 Enrollment ID: I20180105000422 |
| Provider Name | Cassandra L Kotnik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295200624 PECOS PAC ID: 4587918164 Enrollment ID: I20181117000162 |
| Provider Name | Duane D Dale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366906661 PECOS PAC ID: 3678813003 Enrollment ID: I20190322000187 |
| Provider Name | Alex Lee Mullins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013462738 PECOS PAC ID: 1658659081 Enrollment ID: I20201109002149 |
| Provider Name | Heather Jo Mantsch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609488964 PECOS PAC ID: 2365858313 Enrollment ID: I20210317000851 |
| Provider Name | Taylor J Westin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336895242 PECOS PAC ID: 1052706678 Enrollment ID: I20220317002358 |
| Provider Name | Kathleen K Udovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386398139 PECOS PAC ID: 0244626067 Enrollment ID: I20220404002870 |
| Provider Name | Gabriella Suihkonen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942900071 PECOS PAC ID: 3375907371 Enrollment ID: I20230908002753 |
| Provider Name | Jessica Antoinette Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740502293 PECOS PAC ID: 8527412691 Enrollment ID: I20230922001008 |
| Provider Name | Brooke L. Zupancich |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063983146 PECOS PAC ID: 4789029349 Enrollment ID: I20240305002955 |
| Provider Name | Jessie M Perkovich |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730510371 PECOS PAC ID: 2769827344 Enrollment ID: I20240305003543 |
| Provider Name | Megan Marie Bickford |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831979681 PECOS PAC ID: 4587001292 Enrollment ID: I20240318001088 |
| Provider Name | Tracey Anne Lexvold |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134856586 PECOS PAC ID: 4284071804 Enrollment ID: I20240319001267 |
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