| Creative Psychopharmacology Inc | |
|
701 25th Ave S #303 Minneapolis MN 55454-1513 | |
| (612) 333-9954 | |
| (612) 333-9969 |
| Full Name | Creative Psychopharmacology Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 701 25th Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Jessie Brueske (OFFICE MANAGER) |
| Authorized Official Contact | 6123339954 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Psychopharmacology Inc 701 25th Ave S #303 Minneapolis MN 55454-1513 Ph: (612) 333-9954 | Creative Psychopharmacology Inc 701 25th Ave S #303 Minneapolis MN 55454-1513 Ph: (612) 333-9954 |
| NPI Number | 1265621874 |
|---|---|
| Provider Enumeration Date | 10/19/2007 |
| Last Update Date | 10/19/2007 |
| Medicare PECOS PAC ID | 3971684218 |
|---|---|
| Medicare Enrollment ID | O20080114000078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265621874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 9076412 (Minnesota) | Primary |
| Provider Name | John E Simon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255374609 PECOS PAC ID: 7911972534 Enrollment ID: I20060725000378 |
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