| North Central Ministry Development Center, Inc. | |
|
516 Mission House Ln New Brighton MN 55112-2571 | |
| (651) 636-5120 | |
| (651) 636-5124 |
| Full Name | North Central Ministry Development Center, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 516 Mission House Ln, New Brighton, Minnesota |
| Authorized Official Name and Position | Mark Elmer Sundby (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6516365120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Central Ministry Development Center, Inc. 516 Mission House Ln New Brighton MN 55112-2571 Ph: (651) 636-5120 | North Central Ministry Development Center, Inc. 516 Mission House Ln New Brighton MN 55112-2571 Ph: (651) 636-5120 |
| NPI Number | 1164711735 |
|---|---|
| Provider Enumeration Date | 04/04/2011 |
| Last Update Date | 01/22/2014 |
| Medicare PECOS PAC ID | 7214346345 |
|---|---|
| Medicare Enrollment ID | O20210503000006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164711735 | NPI | - | NPPES |
| Provider Name | Mark E Sundby |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710278502 PECOS PAC ID: 3577793272 Enrollment ID: I20140225001177 |
| Provider Name | Kari J Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508938630 PECOS PAC ID: 1951630052 Enrollment ID: I20190916002305 |
| Provider Name | Drew D Benson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093282287 PECOS PAC ID: 3375952773 Enrollment ID: I20210521002037 |
| Provider Name | Daniel J Elenz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417558321 PECOS PAC ID: 6406247782 Enrollment ID: I20211221000848 |
| Provider Name | Kristen Y Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295499283 PECOS PAC ID: 5496146631 Enrollment ID: I20211227000541 |
| Provider Name | Meredith A Martyr |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437828894 PECOS PAC ID: 7719378710 Enrollment ID: I20211230001334 |
| Provider Name | Sarah E Parker |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1245861798 PECOS PAC ID: 5193168771 Enrollment ID: I20240212000129 |
| Provider Name | Jeffrey A Glover |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477788461 PECOS PAC ID: 1658722236 Enrollment ID: I20240227002434 |
| Provider Name | Kathleen P Gullo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982776555 PECOS PAC ID: 0547605503 Enrollment ID: I20240229000892 |
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