| Caspersen Therapy Center | |
|
4284 Dahlberg Dr Golden Valley MN 55422-4805 | |
| (952) 428-6332 | |
| (952) 562-2827 |
| Full Name | Caspersen Therapy Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 4284 Dahlberg Dr, Golden Valley, Minnesota |
| Authorized Official Name and Position | John R. Stillman (OWNER) |
| Authorized Official Contact | 6125582705 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Caspersen Therapy Center 4284 Dahlberg Dr Golden Valley MN 55422-4805 Ph: (952) 428-6332 | Caspersen Therapy Center 4284 Dahlberg Dr Golden Valley MN 55422-4805 Ph: (952) 428-6332 |
| NPI Number | 1225326036 |
|---|---|
| Provider Enumeration Date | 07/13/2011 |
| Last Update Date | 07/13/2021 |
| Certification Date | 07/13/2021 |
| Medicare PECOS PAC ID | 4587997259 |
|---|---|
| Medicare Enrollment ID | O20190612000608 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225326036 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 12770 (Minnesota) | Primary |
| Provider Name | John R Stillman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710920608 PECOS PAC ID: 8729066030 Enrollment ID: I20040713000385 |
| Provider Name | Martha Anderson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1063431815 PECOS PAC ID: 8426400508 Enrollment ID: I20240115001430 |
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