| Level Up Mental Health Collaborative | |
|
2300 Library Cir Grand Forks ND 58201-6328 | |
| (017) 570-4777 | |
| (001) 772-1763 |
| Full Name | Level Up Mental Health Collaborative |
|---|---|
| Speciality | Social Worker |
| Location | 2300 Library Cir, Grand Forks, North Dakota |
| Authorized Official Name and Position | Lacy Suby (OWNER) |
| Authorized Official Contact | 7013304348 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Level Up Mental Health Collaborative 2300 Library Cir Grand Forks ND 58201-6328 Ph: (701) 757-0477 | Level Up Mental Health Collaborative 2300 Library Cir Grand Forks ND 58201-6328 Ph: (017) 570-4777 |
| NPI Number | 1609493329 |
|---|---|
| Provider Enumeration Date | 06/29/2020 |
| Last Update Date | 07/09/2021 |
| Certification Date | 07/09/2021 |
| Medicare PECOS PAC ID | 2163840448 |
|---|---|
| Medicare Enrollment ID | O20200918000650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609493329 | NPI | - | NPPES |
| 1476569 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lacy M Suby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023540804 PECOS PAC ID: 3072858281 Enrollment ID: I20181217001503 |
| Provider Name | Casey N Davidson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568998391 PECOS PAC ID: 3577934355 Enrollment ID: I20230116000548 |
| Provider Name | Jenna L Holtz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215461942 PECOS PAC ID: 8820334352 Enrollment ID: I20230831001808 |
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