Southern Valley Psychology Clinic, Pa | |
11 Civic Center Plz Ste 201 Mankato MN 56001-7710 | |
(507) 385-7725 | |
(507) 385-0576 |
Full Name | Southern Valley Psychology Clinic, Pa |
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Speciality | Counselor |
Location | 11 Civic Center Plz, Mankato, Minnesota |
Authorized Official Name and Position | Barbara Glass (PARTNER) |
Authorized Official Contact | 5073857725 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Southern Valley Psychology Clinic, Pa 11 Civic Center Plz Ste 201 Mankato MN 56001-7710 Ph: (507) 385-7725 | Southern Valley Psychology Clinic, Pa 11 Civic Center Plz Ste 201 Mankato MN 56001-7710 Ph: (507) 385-7725 |
NPI Number | 1407990807 |
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Provider Enumeration Date | 02/18/2007 |
Last Update Date | 02/04/2013 |
Medicare PECOS PAC ID | 0042235590 |
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Medicare Enrollment ID | O20051013000382 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407990807 | NPI | - | NPPES |
318G1SO | Other | MN | BLUE CROSS |
241913100 | Medicaid | MN | |
1383 | Other | MN | UCARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Jacquelyn M Jauss |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1235273624 PECOS PAC ID: 1557386018 Enrollment ID: I20051013000440 |
Provider Name | Barbara C Glass |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1417091810 PECOS PAC ID: 9739104290 Enrollment ID: I20051013000486 |
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