| Brian Arthur Nystrom, LICSW, LMFT | |
|
Brighton Professional Bldg, 1900 Silver Lake Road #110, New Brighton, MN 55112-1789 | |
| (651) 628-9566 | |
| (651) 628-0411 |
| Full Name | Brian Arthur Nystrom |
|---|---|
| Gender | Male |
| Speciality | Social Worker - Clinical |
| Location | Brighton Professional Bldg, New Brighton, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326075813 | NPI | - | NPPES |
| 001857100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 06197 (Minnesota) | Primary |
| 106H00000X | Marriage & Family Therapist | 0145 (Minnesota) | Secondary |
| Entity Name | Nystrom & Associates Ltd |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1396750188 PECOS PAC ID: 6406752492 Enrollment ID: O20031210000592 |
| Entity Name | Family Support Services Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467549220 PECOS PAC ID: 0244297448 Enrollment ID: O20041220000008 |
| Mailing Address | Practice Location Address |
|---|---|
| Brian Arthur Nystrom, LICSW, LMFT Brighton Professional Bldg, 1900 Silver Lake Road #110, New Brighton, NE 55112-1789 Ph: (651) 628-9566 | Brian Arthur Nystrom, LICSW, LMFT Brighton Professional Bldg, 1900 Silver Lake Road #110, New Brighton, MN 55112-1789 Ph: (651) 628-9566 |
Bethany Gavic, MSW, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1900 Silver Lake Rd Nw, Suite 110, New Brighton, MN 55112 Phone: 651-628-9566 Fax: 651-628-0411 | |
Kathleen Ann Spiry, LICSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 1900 Silver Lake Rd Nw, Suite 110, New Brighton, MN 55112 Phone: 651-628-9566 | |
Ifeoma Odor, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1900 Silver Lake Rd Nw Ste 110, New Brighton, MN 55112 Phone: 651-628-9566 Fax: 651-628-0411 | |
Erica Christine Gwillim, MSW, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1900 Silver Lake Rd Nw, Suite 110, New Brighton, MN 55112 Phone: 651-628-9253 Fax: 651-631-8789 | |
Abigail Joy Petersen, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1900 Silver Lake Rd Nw Ste 110, New Brighton, MN 55112 Phone: 763-477-1367 | |
Sarah Jane Gross, MSW, LICSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 1900 Silver Lake Rd #110, New Brighton, MN 55112 Phone: 651-628-9566 Fax: 651-628-0411 | |
Suzanne Maria Lee Crawford Natysin, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 900 Long Lake Rd Ste 160, New Brighton, MN 55112 Phone: 612-706-9630 |