| Enlightenment Psychiatry Llc | |
|
1011 1st St E Ste 5 Park Rapids MN 56470-1764 | |
| (320) 321-9599 | |
| (877) 962-3624 |
| Full Name | Enlightenment Psychiatry Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1011 1st St E Ste 5, Park Rapids, Minnesota |
| Authorized Official Name and Position | Mackenzie Snortum (PMHNP/FOUNDER) |
| Authorized Official Contact | 3203219599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enlightenment Psychiatry Llc 1011 1st St E Ste 5 Park Rapids MN 56470-1764 Ph: (320) 321-9599 | Enlightenment Psychiatry Llc 1011 1st St E Ste 5 Park Rapids MN 56470-1764 Ph: (320) 321-9599 |
| NPI Number | 1629737473 |
|---|---|
| Provider Enumeration Date | 12/09/2021 |
| Last Update Date | 10/09/2024 |
| Medicare PECOS PAC ID | 0143607440 |
|---|---|
| Medicare Enrollment ID | O20220505002413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629737473 | NPI | - | NPPES |
| 1013555887 | Other | MN | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Delores A Alleckson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184857021 PECOS PAC ID: 2163568577 Enrollment ID: I20091014000749 |
| Provider Name | Paula Sue Tofte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902192610 PECOS PAC ID: 2062670326 Enrollment ID: I20120225000124 |
| Provider Name | Macayla R Lindenfelser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013422021 PECOS PAC ID: 3870853849 Enrollment ID: I20180213000440 |
| Provider Name | Mackenzie V Snortum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013555887 PECOS PAC ID: 5496180747 Enrollment ID: I20200115001854 |
| Provider Name | Cassie Renee Rider |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740955814 PECOS PAC ID: 1052703345 Enrollment ID: I20220118002597 |
| Provider Name | Amanda Sue Wollschlager |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720787237 PECOS PAC ID: 4082079843 Enrollment ID: I20230430000033 |
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