| Optimal Brain Mn, Pllc | |
|
992 Inwood Ave Oakdale MN 55128 | |
| (651) 263-4438 | |
| Not Available |
| Full Name | Optimal Brain Mn, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 992 Inwood Ave, Oakdale, Minnesota |
| Authorized Official Name and Position | Calsey Fasching (FOUNDER) |
| Authorized Official Contact | 6512634438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Brain Mn, Pllc 992 Inwood Ave Oakdale MN 55128 Ph: (651) 263-4438 | Optimal Brain Mn, Pllc 992 Inwood Ave Oakdale MN 55128 Ph: (651) 263-4438 |
| NPI Number | 1609614957 |
|---|---|
| Provider Enumeration Date | 07/19/2024 |
| Last Update Date | 07/19/2024 |
| Certification Date | 07/19/2024 |
| Medicare PECOS PAC ID | 6709317787 |
|---|---|
| Medicare Enrollment ID | O20241001002954 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609614957 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Randall L Morris Ostrom |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174891618 PECOS PAC ID: 4385901347 Enrollment ID: I20171129001015 |
| Provider Name | Calsey E Fasching |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194232975 PECOS PAC ID: 5496015067 Enrollment ID: I20190111001330 |
| Provider Name | Michelle C Holt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487210159 PECOS PAC ID: 0840526299 Enrollment ID: I20190724000264 |
| Provider Name | Roseline Yang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912681818 PECOS PAC ID: 0244694248 Enrollment ID: I20230908002914 |
| Provider Name | Violet Marie Wurtzberger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396319679 PECOS PAC ID: 8729438064 Enrollment ID: I20231228001147 |
| Provider Name | Laura A Cada |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497417398 PECOS PAC ID: 4284079344 Enrollment ID: I20240228002168 |
| Provider Name | Whitney S Hinrichs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811414584 PECOS PAC ID: 9032554688 Enrollment ID: I20240305002212 |
| Provider Name | Brittanie Omodt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356930960 PECOS PAC ID: 0345689139 Enrollment ID: I20240412001054 |
| Provider Name | Jared B Lee |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1306397591 PECOS PAC ID: 3971041781 Enrollment ID: I20240812002168 |
| Provider Name | Kevin A Johnson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1154941474 PECOS PAC ID: 4789124892 Enrollment ID: I20240904001416 |
| Provider Name | Lana M Loomis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376370023 PECOS PAC ID: 6002340015 Enrollment ID: I20241113004255 |
| Provider Name | Christina G Copeland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437498896 PECOS PAC ID: 3971039850 Enrollment ID: I20241216002776 |
| Provider Name | Alisha D Bauman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891501912 PECOS PAC ID: 0547790719 Enrollment ID: I20250204002077 |
| Provider Name | Katarina Marsh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376396903 PECOS PAC ID: 1658880992 Enrollment ID: I20250529003720 |
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