| Sioux Trails Mental Health Center, Inc | |
|
1407 S State St New Ulm MN 56073 | |
| (507) 354-3181 | |
| (507) 354-3183 |
| Full Name | Sioux Trails Mental Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1407 S State St, New Ulm, Minnesota |
| Authorized Official Name and Position | Catherine Job (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5073543181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sioux Trails Mental Health Center, Inc 1407 S State St New Ulm MN 56073 Ph: (507) 354-3181 | Sioux Trails Mental Health Center, Inc 1407 S State St New Ulm MN 56073 Ph: (507) 354-3181 |
| NPI Number | 1902909914 |
|---|---|
| Provider Enumeration Date | 09/06/2006 |
| Last Update Date | 04/22/2015 |
| Medicare PECOS PAC ID | 2163313370 |
|---|---|
| Medicare Enrollment ID | O20040324001134 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902909914 | NPI | - | NPPES |
| 4320451 | Other | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Melissa K Coble |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780613596 PECOS PAC ID: 7911934849 Enrollment ID: I20050722000390 |
| Provider Name | Lora R Bagur |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518262377 PECOS PAC ID: 8224274212 Enrollment ID: I20130417000585 |
| Provider Name | Jessica Estes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487632709 PECOS PAC ID: 7113959867 Enrollment ID: I20170216002072 |
| Provider Name | Melissa Jo Groskreutz |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1255362281 PECOS PAC ID: 1153696521 Enrollment ID: I20171011001283 |
| Provider Name | April Ann Hegdahl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720597487 PECOS PAC ID: 4789932823 Enrollment ID: I20180806001127 |
| Provider Name | Brad Vanover |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316413099 PECOS PAC ID: 7618212887 Enrollment ID: I20181215000227 |
| Provider Name | Starr L Dunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922211226 PECOS PAC ID: 6103980792 Enrollment ID: I20190205002222 |
| Provider Name | Alexis L Cote-sands |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144792664 PECOS PAC ID: 5890033427 Enrollment ID: I20190206002491 |
| Provider Name | Ediomi Edet Enebong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356996326 PECOS PAC ID: 5496086001 Enrollment ID: I20211209002599 |
| Provider Name | Janet A Mason |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013558667 PECOS PAC ID: 2668858101 Enrollment ID: I20221010000484 |
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