| Northeast Counseling, P.a. | |
|
2127 County Road D E Ste A100 Maplewood MN 55109-5350 | |
| (651) 592-1592 | |
| (651) 429-2988 |
| Full Name | Northeast Counseling, P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2127 County Road D E Ste A100, Maplewood, Minnesota |
| Authorized Official Name and Position | Tim G Scott (PRESIDENT) |
| Authorized Official Contact | 6513986341 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Counseling, P.a. 2127 County Road D E Ste A100 Maplewood MN 55109-5350 Ph: (651) 592-1592 | Northeast Counseling, P.a. 2127 County Road D E Ste A100 Maplewood MN 55109-5350 Ph: (651) 592-1592 |
| NPI Number | 1053596577 |
|---|---|
| Provider Enumeration Date | 01/03/2008 |
| Last Update Date | 04/02/2018 |
| Medicare PECOS PAC ID | 6608048541 |
|---|---|
| Medicare Enrollment ID | O20111018000823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053596577 | NPI | - | NPPES |
| 1053596577 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Clayton David Sankey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003863531 PECOS PAC ID: 9032172879 Enrollment ID: I20041111000728 |
| Provider Name | Debra Kay Kratz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811031180 PECOS PAC ID: 6507038445 Enrollment ID: I20111101000779 |
| Provider Name | Timothy Gerard Scott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548304850 PECOS PAC ID: 7315119252 Enrollment ID: I20111101000785 |
| Provider Name | Daniel Hinderaker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467908277 PECOS PAC ID: 8628334687 Enrollment ID: I20171107001522 |
| Provider Name | Jael A Were |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1639403967 PECOS PAC ID: 9133572449 Enrollment ID: I20240201003917 |
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