| Northland Counseling Center, Inc. | |
|
215 Se 2nd Ave Grand Rapids MN 55744-3615 | |
| (218) 326-1274 | |
| Not Available |
| Full Name | Northland Counseling Center, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 215 Se 2nd Ave, Grand Rapids, Minnesota |
| Authorized Official Name and Position | K. Greg Walker (CEO) |
| Authorized Official Contact | 2183260099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northland Counseling Center, Inc. 215 Se 2nd Ave Grand Rapids MN 55744-3615 Ph: () - | Northland Counseling Center, Inc. 215 Se 2nd Ave Grand Rapids MN 55744-3615 Ph: (218) 326-1274 |
| NPI Number | 1164610986 |
|---|---|
| Provider Enumeration Date | 10/05/2007 |
| Last Update Date | 10/05/2007 |
| Medicare PECOS PAC ID | 1153389242 |
|---|---|
| Medicare Enrollment ID | O20041221000396 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164610986 | NPI | - | NPPES |
| 72560NO | Other | MN | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Thomas Kefalas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609842897 PECOS PAC ID: 4880886019 Enrollment ID: I20101006001178 |
| Provider Name | Allison O'hara Meyers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134498009 PECOS PAC ID: 5193970671 Enrollment ID: I20130307000254 |
| Provider Name | Angela Christian Pellerito |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891186482 PECOS PAC ID: 8325366453 Enrollment ID: I20150421001258 |
| Provider Name | Laura B Maxwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003261470 PECOS PAC ID: 0547559577 Enrollment ID: I20160516000656 |
| Provider Name | Brea J Wallaker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972098440 PECOS PAC ID: 7214280387 Enrollment ID: I20181019001945 |
| Provider Name | Dannielle C Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538649223 PECOS PAC ID: 8224381736 Enrollment ID: I20181031001094 |
| Provider Name | Dessa M Bergan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083197024 PECOS PAC ID: 3870847148 Enrollment ID: I20181127000018 |
| Provider Name | Melanie Nicole Troumbly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447832746 PECOS PAC ID: 0547660011 Enrollment ID: I20210621002800 |
| Provider Name | Kerrie Rae Humble |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649936170 PECOS PAC ID: 8325438146 Enrollment ID: I20211209000240 |
| Provider Name | April J Krause |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578343935 PECOS PAC ID: 4880043728 Enrollment ID: I20231218001519 |
| Provider Name | Ana L. Pereira |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1356659429 PECOS PAC ID: 8921442013 Enrollment ID: I20240216001051 |
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