| Eagan Counseling Clinic | |
|
3450 Oleary Ln Eagan MN 55123-2340 | |
| (651) 454-0114 | |
| (651) 454-3492 |
| Full Name | Eagan Counseling Clinic |
|---|---|
| Speciality | Psychologist |
| Location | 3450 Oleary Ln, Eagan, Minnesota |
| Authorized Official Name and Position | Peggy Dominic (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6513658217 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagan Counseling Clinic 3450 Oleary Ln Eagan MN 55123-2340 Ph: (651) 454-0114 | Eagan Counseling Clinic 3450 Oleary Ln Eagan MN 55123-2340 Ph: (651) 454-0114 |
| NPI Number | 1144311184 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 04/10/2008 |
| Medicare PECOS PAC ID | 2860304045 |
|---|---|
| Medicare Enrollment ID | O20031105000326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144311184 | NPI | - | NPPES |
| 800084 | Other | MN | PREFERRED ONE |
| 59280EA | Other | MN | BCBS |
| 00892 | Other | MN | HEALTH PARTNERS |
| 101973 | Other | MN | UCARE |
| 84-57408 | Other | MN | MEDICA |
| Provider Name | Daniel C Thomason |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629093380 PECOS PAC ID: 4183663537 Enrollment ID: I20050426000946 |
| Provider Name | Sujit R Varma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013018258 PECOS PAC ID: 0840224002 Enrollment ID: I20050927000227 |
| Provider Name | Gary Lee Norman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972644581 PECOS PAC ID: 9537256508 Enrollment ID: I20071107000795 |
| Provider Name | Michael A Donndelinger-beldon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740329234 PECOS PAC ID: 4082771084 Enrollment ID: I20090318000466 |
| Provider Name | Michelle M Tichey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578595492 PECOS PAC ID: 1153450531 Enrollment ID: I20100524000142 |
| Provider Name | Anastasia L Cyptar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376663963 PECOS PAC ID: 1254526791 Enrollment ID: I20101110001005 |
| Provider Name | Molly Cronin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235221441 PECOS PAC ID: 1355516790 Enrollment ID: I20111213000412 |
| Provider Name | Patrick M Doyle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700978061 PECOS PAC ID: 4082526264 Enrollment ID: I20120131000370 |
| Provider Name | Lisa Marie Sorenson-woodhull |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215021266 PECOS PAC ID: 5092972166 Enrollment ID: I20120201000039 |
| Provider Name | Kathleen M Sprole |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770887689 PECOS PAC ID: 5991962383 Enrollment ID: I20120214000462 |
| Provider Name | Rebecca L Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851708259 PECOS PAC ID: 9032331269 Enrollment ID: I20141104000495 |
| Provider Name | Meghan D Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225377088 PECOS PAC ID: 7416273594 Enrollment ID: I20150309000774 |
| Provider Name | Alex Nc Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578802336 PECOS PAC ID: 9436465705 Enrollment ID: I20150901001578 |
| 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 | Amy L Jacky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922437334 PECOS PAC ID: 4183852478 Enrollment ID: I20160719002800 |
| Provider Name | Miranda B Dulek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356896765 PECOS PAC ID: 3678860319 Enrollment ID: I20160923002114 |
| Provider Name | Ann C Fasching |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376044149 PECOS PAC ID: 9133474810 Enrollment ID: I20180620003264 |
| Provider Name | Natalie N Brandsrud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043797848 PECOS PAC ID: 5092064428 Enrollment ID: I20180820000030 |
| Provider Name | Dustin M Jacob |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376967570 PECOS PAC ID: 2264664267 Enrollment ID: I20180821000748 |
| Provider Name | Richard Edwin Close |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457379026 PECOS PAC ID: 9739433970 Enrollment ID: I20181107000624 |
| Provider Name | Elise B Quam |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891269155 PECOS PAC ID: 7810238367 Enrollment ID: I20190409003460 |
| Provider Name | Jessica D Maryniuk |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396140422 PECOS PAC ID: 1850632324 Enrollment ID: I20190410000992 |
| Provider Name | Danielle L Kuka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568937092 PECOS PAC ID: 2163763657 Enrollment ID: I20190410001704 |
| Provider Name | Lauren E Daniel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164899944 PECOS PAC ID: 9537400056 Enrollment ID: I20190412001827 |
| Provider Name | Joshua Hampton Goodwin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730733098 PECOS PAC ID: 6507196201 Enrollment ID: I20190923003261 |
| Provider Name | Brigit M Kotzky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265780191 PECOS PAC ID: 9739513532 Enrollment ID: I20200103001195 |
| Provider Name | Kaibeh Benson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265065114 PECOS PAC ID: 1052741865 Enrollment ID: I20200420000216 |
| Provider Name | Ellen C Solis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922560788 PECOS PAC ID: 4385067164 Enrollment ID: I20200713001635 |
| Provider Name | Lisa J Rutman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194334318 PECOS PAC ID: 5395163984 Enrollment ID: I20200914002255 |
| Provider Name | Emiily E Glover |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033630967 PECOS PAC ID: 5193136901 Enrollment ID: I20201201000244 |
| Provider Name | Shane M Hamp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326655093 PECOS PAC ID: 2264843960 Enrollment ID: I20201202001043 |
| Provider Name | Avery R Luft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053823294 PECOS PAC ID: 8921356866 Enrollment ID: I20210630003124 |
| Provider Name | Kimberly R Debeer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437822558 PECOS PAC ID: 1355746702 Enrollment ID: I20210823002023 |
| Provider Name | Laurie M Wollman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992485130 PECOS PAC ID: 4486018611 Enrollment ID: I20230906003832 |
| Provider Name | Angela K Krebs |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1508910530 PECOS PAC ID: 3274984331 Enrollment ID: I20240112002826 |
| Provider Name | Daniel B Redman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1669962510 PECOS PAC ID: 6800274200 Enrollment ID: I20240116001184 |
| Provider Name | Sharon A Flom |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1689449209 PECOS PAC ID: 0547612186 Enrollment ID: I20240118003247 |
| Provider Name | Sydney R Keeler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164004479 PECOS PAC ID: 1951753821 Enrollment ID: I20240126003147 |
| Provider Name | Kathryn T Reinholdt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790311801 PECOS PAC ID: 3971955980 Enrollment ID: I20240131002430 |
| Provider Name | Amber L Schupp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720215171 PECOS PAC ID: 7012369085 Enrollment ID: I20240131002769 |
| Provider Name | Heather E Oleson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518324706 PECOS PAC ID: 7618329640 Enrollment ID: I20240205001633 |
| Provider Name | Laura K Jayroe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053184267 PECOS PAC ID: 3870936065 Enrollment ID: I20240205001888 |
| Provider Name | Scarlett H O'connell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073388542 PECOS PAC ID: 8820431034 Enrollment ID: I20240205002461 |
| Provider Name | Callie K Peterson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1134817042 PECOS PAC ID: 6406299627 Enrollment ID: I20240205002999 |
| Provider Name | Lawrene L Sedlacek |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093288987 PECOS PAC ID: 6204279433 Enrollment ID: I20240205003091 |
| Provider Name | Carol S Elstad |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518574672 PECOS PAC ID: 6305295023 Enrollment ID: I20240206001672 |
| Provider Name | Janel M Oberg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023427226 PECOS PAC ID: 3173974482 Enrollment ID: I20240228000163 |
| Provider Name | Brian L Nelson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669930012 PECOS PAC ID: 5496106635 Enrollment ID: I20240228001077 |
| Provider Name | Mara J Fusco |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568949774 PECOS PAC ID: 3678922390 Enrollment ID: I20240301002941 |
| Provider Name | Matthew S Carlson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023290632 PECOS PAC ID: 3476902727 Enrollment ID: I20240304000314 |
| Provider Name | Mary A Freitag |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992369664 PECOS PAC ID: 7416306808 Enrollment ID: I20240307000513 |
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