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5407 Excelsior Boulevard Suite B Saint Louis Park MN 55416-2932 | |
| (612) 787-2832 | |
| (952) 920-9323 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 5407 Excelsior Boulevard, Saint Louis Park, Minnesota |
| Authorized Official Name and Position | Deeetta Marie Juve (BILLING ASSOCIATE) |
| Authorized Official Contact | 6125581699 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5407 Excelsior Boulevard Suite B Saint Louis Park MN 55416-2932 Ph: (612) 787-2832 | 5407 Excelsior Boulevard Suite B Saint Louis Park MN 55416-2932 Ph: (612) 787-2832 |
| NPI Number | 1376687285 |
|---|---|
| Provider Enumeration Date | 02/16/2007 |
| Last Update Date | 09/11/2024 |
| Certification Date | 09/11/2024 |
| Medicare PECOS PAC ID | 7810429222 |
|---|---|
| Medicare Enrollment ID | O20241010000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376687285 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Callie Joyce Mcmillan |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1033631288 PECOS PAC ID: 0345772612 Enrollment ID: I20241011003084 |
| Provider Name | Allison Lynn Rose |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1720647753 PECOS PAC ID: 0244763787 Enrollment ID: I20241023001069 |
| Provider Name | Carol Hoopman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1104484997 PECOS PAC ID: 7315470879 Enrollment ID: I20241023001561 |
| Provider Name | Nancy L Carlson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1669623757 PECOS PAC ID: 5799218939 Enrollment ID: I20241028000787 |
| Provider Name | Rachel Nygaard |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275191447 PECOS PAC ID: 6305379025 Enrollment ID: I20241101001282 |
| Provider Name | Theresa Benoit |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1942469267 PECOS PAC ID: 0345772752 Enrollment ID: I20241104002475 |
| Provider Name | Efren Francisco Solanas |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1609434174 PECOS PAC ID: 5799218384 Enrollment ID: I20241105000442 |
| Provider Name | Jebediah Joel Sawyer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376770941 PECOS PAC ID: 8527590934 Enrollment ID: I20241105000856 |
| Provider Name | Amanda Marie Tapper |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1861941684 PECOS PAC ID: 2769916345 Enrollment ID: I20241106000751 |
| Provider Name | Gregory Schacher |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1255632972 PECOS PAC ID: 8325572803 Enrollment ID: I20241106001038 |
| Provider Name | Layne Ticker |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1336541390 PECOS PAC ID: 3577098664 Enrollment ID: I20241126003191 |
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Act Psychological Services, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4601 Excelsior Blvd Ste 507a, Saint Louis Park, MN 55416 Phone: 612-836-3886 | |
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Neurology Specialists, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4500 Park Glen Road, Suite 160, Saint Louis Park, MN 55416 Phone: 952-767-7771 Fax: 952-767-7774 | |
Nancy Hawkins & Associates Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 4500 Park Glen Rd, Suite 360, Saint Louis Park, MN 55416 Phone: 952-929-9478 Fax: 952-929-9548 |