| Lifestance Health | |
|
1833 3rd Ave Anoka MN 55303-2424 | |
| (763) 421-5535 | |
| (763) 433-0226 |
| Full Name | Lifestance Health |
|---|---|
| Speciality | Psychologist |
| Location | 1833 3rd Ave, Anoka, Minnesota |
| Authorized Official Name and Position | Ryan Pardo (CHIEF LEGAL OFFICER) |
| Authorized Official Contact | 2063991493 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifestance Health 1833 3rd Ave Anoka MN 55303-2424 Ph: (763) 421-5535 | Lifestance Health 1833 3rd Ave Anoka MN 55303-2424 Ph: (763) 421-5535 |
| NPI Number | 1992862783 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 03/20/2024 |
| Certification Date | 03/20/2024 |
| Medicare PECOS PAC ID | 6204178528 |
|---|---|
| Medicare Enrollment ID | O20190506002814 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992862783 | NPI | - | NPPES |
| 211588 | Other | MN | COMPSYCH EAP |
| 086M6FA | Other | MN | BLUE CROSS BLUE SHIELD |
| 04033007 | Other | MN | METROPOLITAN HEALTH PLAN |
| 300P0FA | Other | MN | BLUE CROSS BLUE SHIELD |
| 48G90FA | Other | MN | BLUE CROSS BLUE SHIELD |
| 81312 | Other | MN | HEALTH PARTNERS |
| 026665500 | Medicaid | MN |
| Provider Name | Gerald P Crimmins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063499499 PECOS PAC ID: 9830087279 Enrollment ID: I20040308001109 |
| Provider Name | Tamara Lonelle Mason |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205813581 PECOS PAC ID: 6901893833 Enrollment ID: I20040430000594 |
| Provider Name | Cynthia A Barsness |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518972009 PECOS PAC ID: 4385605120 Enrollment ID: I20041025000497 |
| Provider Name | Joel A Schirvar |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073593620 PECOS PAC ID: 9335187947 Enrollment ID: I20050422000598 |
| Provider Name | Jill M Gray |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124124045 PECOS PAC ID: 5799727095 Enrollment ID: I20050526000515 |
| Provider Name | Tamara P Clement |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144392333 PECOS PAC ID: 7315045192 Enrollment ID: I20070601000029 |
| Provider Name | Gretchen M Zunkel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376507129 PECOS PAC ID: 4284687393 Enrollment ID: I20100216000305 |
| Provider Name | Kathryn M Manning |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134195506 PECOS PAC ID: 0840238689 Enrollment ID: I20100909000533 |
| Provider Name | Nicole Tauer Ward |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497901532 PECOS PAC ID: 7517110224 Enrollment ID: I20130109000097 |
| Provider Name | Warren B Fritze |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295078715 PECOS PAC ID: 3577701226 Enrollment ID: I20130607000474 |
| Provider Name | Elizabeth Islay Mcpeek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093191603 PECOS PAC ID: 3678883048 Enrollment ID: I20151116000428 |
| Provider Name | Peggy L Mcnicholes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598146094 PECOS PAC ID: 8325341308 Enrollment ID: I20160126000490 |
| Provider Name | Jacqueline Rose Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265719520 PECOS PAC ID: 8426357005 Enrollment ID: I20160503001904 |
| Provider Name | Nan C Truitt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629150479 PECOS PAC ID: 2860610847 Enrollment ID: I20180605001297 |
| Provider Name | Chinwe C Eke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689858557 PECOS PAC ID: 5395099386 Enrollment ID: I20181109001384 |
| Provider Name | Patrick Paul Westerham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053577361 PECOS PAC ID: 0840509717 Enrollment ID: I20190529000546 |
| Provider Name | Elizabeth M Storm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205466463 PECOS PAC ID: 6305276874 Enrollment ID: I20200423003110 |
| Provider Name | Mia R Wintheiser |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871851899 PECOS PAC ID: 5395043236 Enrollment ID: I20200526001616 |
| Provider Name | Lisa Marie Moen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578080743 PECOS PAC ID: 6608290036 Enrollment ID: I20200720000205 |
| Provider Name | Anna Krull |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700042801 PECOS PAC ID: 6406276385 Enrollment ID: I20201014002181 |
| Provider Name | Steven Kaspari Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679058127 PECOS PAC ID: 2062821242 Enrollment ID: I20210430000038 |
| Provider Name | Amanda Christine Stappler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629615976 PECOS PAC ID: 4183023005 Enrollment ID: I20210526001980 |
| Provider Name | Elizabeth M Crubaugh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700548336 PECOS PAC ID: 2264822931 Enrollment ID: I20211213000831 |
| Provider Name | Kara Ann Engebretson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336620137 PECOS PAC ID: 8224429105 Enrollment ID: I20220104000528 |
| Provider Name | Phoebe Kerubo Nyabando |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174190466 PECOS PAC ID: 5890175095 Enrollment ID: I20220706001619 |
| Provider Name | Joy Marie Kubis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891498754 PECOS PAC ID: 3173989910 Enrollment ID: I20230519001808 |
| Provider Name | Anthony George Shabrack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073214839 PECOS PAC ID: 3173989944 Enrollment ID: I20230521000016 |
| Provider Name | Tsering Dolma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245966373 PECOS PAC ID: 2668831678 Enrollment ID: I20230710001360 |
| Provider Name | Rahma Sheikh-dahir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609591809 PECOS PAC ID: 0345600771 Enrollment ID: I20230718000837 |
| Provider Name | Maria R Metry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376235176 PECOS PAC ID: 7416301577 Enrollment ID: I20230925000679 |
| Provider Name | Brittney Lindsey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386311975 PECOS PAC ID: 9234527987 Enrollment ID: I20231221003212 |
| Provider Name | Christina Heather Owens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720671357 PECOS PAC ID: 4385094556 Enrollment ID: I20231229002228 |
| Provider Name | Katherine Fisher |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1396135349 PECOS PAC ID: 9133572712 Enrollment ID: I20240131000397 |
| Provider Name | Brigit Wingert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932893658 PECOS PAC ID: 9537512124 Enrollment ID: I20240131000589 |
| Provider Name | Christina Danielle Bourgeois |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265200166 PECOS PAC ID: 6204289739 Enrollment ID: I20240131002219 |
| Provider Name | Amanda Mcmanus |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1689069718 PECOS PAC ID: 3476997800 Enrollment ID: I20240214000071 |
| Provider Name | Kelli Marie Jongekryg |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1194964890 PECOS PAC ID: 8729422159 Enrollment ID: I20240214000109 |
| Provider Name | Janna Rae Morehead |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1912604943 PECOS PAC ID: 1153765581 Enrollment ID: I20240214000191 |
| Provider Name | Christin Joy Oien |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1831465996 PECOS PAC ID: 9133563562 Enrollment ID: I20240214000252 |
| Provider Name | Brittany Stark |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1083248025 PECOS PAC ID: 4486071727 Enrollment ID: I20240214000339 |
| Provider Name | Drew Nelson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033877071 PECOS PAC ID: 3678917010 Enrollment ID: I20240214000357 |
| Provider Name | Julie Bosacker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043635055 PECOS PAC ID: 3577907922 Enrollment ID: I20240214000759 |
| Provider Name | Corinne Melling |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1205085768 PECOS PAC ID: 2860836228 Enrollment ID: I20240214001016 |
| Provider Name | Shanna Lee Frenzen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1639237852 PECOS PAC ID: 4789028150 Enrollment ID: I20240214001403 |
| Provider Name | Rollen Benjamin Twogood |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1689159840 PECOS PAC ID: 6002250479 Enrollment ID: I20240214001533 |
| Provider Name | Jeffrey Paul Schewe |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1780742742 PECOS PAC ID: 6002250388 Enrollment ID: I20240214002311 |
| Provider Name | Cj (crystal) Jundt |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1316600273 PECOS PAC ID: 2365886694 Enrollment ID: I20240214003943 |
| Provider Name | Meghan Michelle Swenson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1841439544 PECOS PAC ID: 6709220031 Enrollment ID: I20240214004078 |
| Provider Name | Tonya Scherping |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1619250941 PECOS PAC ID: 4981048089 Enrollment ID: I20240216001587 |
| Provider Name | Katherine Falk |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1427446632 PECOS PAC ID: 0840634713 Enrollment ID: I20240219003084 |
| Provider Name | Melissa Marie Cribb |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861864068 PECOS PAC ID: 7517301302 Enrollment ID: I20240220003892 |
| Provider Name | Nathan Mccormick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306511464 PECOS PAC ID: 2264877703 Enrollment ID: I20240223003468 |
| Provider Name | Laura Cada |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497417398 PECOS PAC ID: 4284079344 Enrollment ID: I20240228002168 |
| Provider Name | Stephanie Marie Burrow |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982277901 PECOS PAC ID: 7618312794 Enrollment ID: I20240228002603 |
| Provider Name | Stefan J Millea |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952980922 PECOS PAC ID: 1951746031 Enrollment ID: I20240228002716 |
| Provider Name | Taren M Dooley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376946871 PECOS PAC ID: 1254776347 Enrollment ID: I20240228003022 |
| Provider Name | Lindsey Schultz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437604501 PECOS PAC ID: 2466897400 Enrollment ID: I20240229000477 |
| Provider Name | Maria Kasl |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720708357 PECOS PAC ID: 2163867052 Enrollment ID: I20240301001347 |
| Provider Name | Amber Rae Jensen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700324480 PECOS PAC ID: 5193161644 Enrollment ID: I20240307000747 |
| Provider Name | Charles Roth Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659724086 PECOS PAC ID: 5991141319 Enrollment ID: I20240307003503 |
| Provider Name | William Joseph Wright |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1962712711 PECOS PAC ID: 6002252988 Enrollment ID: I20240314000058 |
| Provider Name | James Wiencke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316473960 PECOS PAC ID: 1658717327 Enrollment ID: I20240315003553 |
Bliss Mental Wellness Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2503 11th Ave, Anoka, MN 55303 Phone: 952-564-9363 | |
Rhonda Johnson, Msw, Licsw Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2006 1st Ave Ste 101, Anoka, MN 55303 Phone: 952-240-0109 | |
Jrg Solutions Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 550 Madison St Apt 10, Anoka, MN 55303 Phone: 619-920-0800 | |
Chiatoh Enterprize Cte Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4316 Parkview Cir, Anoka, MN 55303 Phone: 651-354-2871 | |
Cor Counseling Services Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 646 E River Rd Ste 1, Anoka, MN 55303 Phone: 637-427-1950 Fax: 763-427-7006 | |
Shalom Mental Health Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3751 Ridge Ave, Anoka, MN 55303 Phone: 515-918-3955 | |
Optiovillage, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 630 E Main St, Anoka, MN 55303 Phone: 763-712-1903 Fax: 763-712-1917 |