| Northern Tranquility Mental Health Services | |
|
12 W Lake St Chisholm MN 55719-1817 | |
| (218) 296-0688 | |
| (844) 921-1071 |
| Full Name | Northern Tranquility Mental Health Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 12 W Lake St, Chisholm, Minnesota |
| Authorized Official Name and Position | Melissa Sue Brusacoram (OWNER, CEO, APRN-CNP, PMHNP-BC) |
| Authorized Official Contact | 2182540101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Tranquility Mental Health Services 12 W Lake St Chisholm MN 55719-1817 Ph: (218) 254-0101 | Northern Tranquility Mental Health Services 12 W Lake St Chisholm MN 55719-1817 Ph: (218) 296-0688 |
| NPI Number | 1700469640 |
|---|---|
| Provider Enumeration Date | 04/29/2021 |
| Last Update Date | 04/17/2023 |
| Certification Date | 04/17/2023 |
| Medicare PECOS PAC ID | 4981009479 |
|---|---|
| Medicare Enrollment ID | O20210820003039 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700469640 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Chandra Lynn White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558618884 PECOS PAC ID: 8820249741 Enrollment ID: I20121126000641 |
| Provider Name | Rebecca Leigh Wachsmuth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194272781 PECOS PAC ID: 3870889157 Enrollment ID: I20160913001645 |
| Provider Name | John Franzen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992166383 PECOS PAC ID: 2062840259 Enrollment ID: I20200323001350 |
| Provider Name | Melissa Sue Brusacoram |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962051359 PECOS PAC ID: 1557686565 Enrollment ID: I20200610002877 |
| Provider Name | Christina Jacklyn Kirchen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134865561 PECOS PAC ID: 2860876729 Enrollment ID: I20220826002078 |
| Provider Name | Karena Beth Rother |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861264947 PECOS PAC ID: 8022460062 Enrollment ID: I20240116001550 |
Nhs Northstar, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 227 W Lake St, Chisholm, MN 55719 Phone: 218-254-5757 Fax: 218-254-9856 | |
Vieau Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 W Lake St Ste 204, Chisholm, MN 55719 Phone: 218-235-1703 Fax: 218-249-1559 |