| Lakeview Behavioral Health Inc. | |
|
516 S Pokegama Ave Grand Rapids MN 55744-3800 | |
| (218) 327-2001 | |
| (218) 327-0456 |
| Full Name | Lakeview Behavioral Health Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 516 S Pokegama Ave, Grand Rapids, Minnesota |
| Authorized Official Name and Position | Thomas Johnson (CEO) |
| Authorized Official Contact | 2183272001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeview Behavioral Health Inc. 516 S Pokegama Ave Grand Rapids MN 55744-3800 Ph: (218) 327-2001 | Lakeview Behavioral Health Inc. 516 S Pokegama Ave Grand Rapids MN 55744-3800 Ph: (218) 327-2001 |
| NPI Number | 1154404325 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 08/20/2021 |
| Certification Date | 08/20/2021 |
| Medicare PECOS PAC ID | 9537432307 |
|---|---|
| Medicare Enrollment ID | O20170830003216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154404325 | NPI | - | NPPES |
| 371225700 | Medicaid | MN | |
| 8974RA | Other | MN | BLUE CROSS BLUE SHIELD |
| 5042493 | Other | MN | MEDICA |
| 122307 | Other | MN | BEHAVIORAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 805713-1-CDT (Minnesota) | Primary |
| Provider Name | Shawna M Benson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447351812 PECOS PAC ID: 7517914252 Enrollment ID: I20050405000324 |
| Provider Name | Stanislav Kruglikov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316048986 PECOS PAC ID: 2860414281 Enrollment ID: I20051229000332 |
| Provider Name | Nancy L Moyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508824889 PECOS PAC ID: 9931113289 Enrollment ID: I20060126000150 |
| Provider Name | Wendy S Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689873598 PECOS PAC ID: 4385731538 Enrollment ID: I20071105000099 |
| Provider Name | Louise M Dewey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407945132 PECOS PAC ID: 6709026149 Enrollment ID: I20130709000345 |
| Provider Name | Thomas F Johnson |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1609051168 PECOS PAC ID: 1254566557 Enrollment ID: I20131022001141 |
| Provider Name | Jody A Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407009384 PECOS PAC ID: 5597991331 Enrollment ID: I20131126001145 |
| Provider Name | Joannah B Bluntach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902293855 PECOS PAC ID: 5597086694 Enrollment ID: I20150601002627 |
| Provider Name | Teresa A Larrabee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598252983 PECOS PAC ID: 5597068650 Enrollment ID: I20180607002791 |
| Provider Name | Stephanie Rae Harnack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063992535 PECOS PAC ID: 4688918501 Enrollment ID: I20181204002277 |
| Provider Name | Rhea Del Rosario |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336789916 PECOS PAC ID: 5193153385 Enrollment ID: I20200323001181 |
| Provider Name | John Franzen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992166383 PECOS PAC ID: 2062840259 Enrollment ID: I20200323001350 |
| Provider Name | Jared Lee Harnack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093249419 PECOS PAC ID: 4183043516 Enrollment ID: I20201002002140 |
| Provider Name | Tammy Lynn Word |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548861016 PECOS PAC ID: 5496163701 Enrollment ID: I20210426000704 |
| Provider Name | Christine Michelle Hanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265042923 PECOS PAC ID: 0244659530 Enrollment ID: I20210809002417 |
| Provider Name | Heather Stuber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518548858 PECOS PAC ID: 4385040898 Enrollment ID: I20210909000366 |
| Provider Name | Diane Elizabeth Tyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760150213 PECOS PAC ID: 6507262821 Enrollment ID: I20210910001659 |
| Provider Name | Megan Gerak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265038053 PECOS PAC ID: 1850781469 Enrollment ID: I20211214000038 |
| Provider Name | Larry Vernon Elj |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376150235 PECOS PAC ID: 9931598570 Enrollment ID: I20211221000999 |
| Provider Name | Tifanie M Reineke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922751155 PECOS PAC ID: 5193119832 Enrollment ID: I20220223001973 |
| Provider Name | Diane Debra Leaders |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366196115 PECOS PAC ID: 9830585892 Enrollment ID: I20220331001441 |
| Provider Name | Jennie Jon Bata |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255506929 PECOS PAC ID: 2961678099 Enrollment ID: I20220831003993 |
| Provider Name | Sarah Ann Donahue |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366141871 PECOS PAC ID: 3476928698 Enrollment ID: I20230331000341 |
| Provider Name | Jessica Plaisted |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477332443 PECOS PAC ID: 1658727052 Enrollment ID: I20231020001832 |
| Provider Name | Peter Strassburg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548601826 PECOS PAC ID: 8325495849 Enrollment ID: I20231106001225 |
| Provider Name | Lisa J Bildeaux |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720699077 PECOS PAC ID: 4486005998 Enrollment ID: I20240109003989 |
| Provider Name | Katherine Schmidtbauer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669062337 PECOS PAC ID: 4082066220 Enrollment ID: I20240123003944 |
| Provider Name | Deidre' Marie Clark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245829548 PECOS PAC ID: 3577969310 Enrollment ID: I20240210000105 |
| Provider Name | Zachary Thomas Kahmeyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770985954 PECOS PAC ID: 8729422829 Enrollment ID: I20240216001504 |
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Itasca Psychiatric Services Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 25 Ne 3rd St, Grand Rapids, MN 55744 Phone: 218-327-2284 Fax: 218-327-3173 | |
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