| Collaborative Psychiatric Services Llc | |
|
5995 Oren Ave N Ste 203 Oak Park Heights MN 55082-6379 | |
| (651) 504-5103 | |
| Not Available |
| Full Name | Collaborative Psychiatric Services Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5995 Oren Ave N Ste 203, Oak Park Heights, Minnesota |
| Authorized Official Name and Position | Justin Gerstner (MANAGING MEMBER) |
| Authorized Official Contact | 6515045103 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Collaborative Psychiatric Services Llc 1406 Hilltop Rdg Houlton WI 54082-2013 Ph: () - | Collaborative Psychiatric Services Llc 5995 Oren Ave N Ste 203 Oak Park Heights MN 55082-6379 Ph: (651) 504-5103 |
| NPI Number | 1699525857 |
|---|---|
| Provider Enumeration Date | 03/22/2024 |
| Last Update Date | 03/25/2024 |
| Certification Date | 03/25/2024 |
| Medicare PECOS PAC ID | 5496196115 |
|---|---|
| Medicare Enrollment ID | O20240513002614 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699525857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Justin A Gerstner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780962670 PECOS PAC ID: 3173755493 Enrollment ID: I20201102000329 |
| Provider Name | Kirby Kaczor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003679234 PECOS PAC ID: 7911341102 Enrollment ID: I20240215001691 |
| Provider Name | Demi Rose Mancini |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932724812 PECOS PAC ID: 3779901384 Enrollment ID: I20250123002391 |
| Provider Name | Ashley Lynn Tix |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1164883773 PECOS PAC ID: 0244769073 Enrollment ID: I20250123003384 |
Vantage Mental Health Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 5995 Oren Ave N Ste 203, Oak Park Heights, MN 55082 Phone: 651-217-1480 Fax: 833-972-5926 | |
Adap Consulting Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5901 Omaha Ave N Lower Level #110, Oak Park Heights, MN 55082 Phone: 952-999-7820 Fax: 952-999-7821 |