| Pathways Psychological Services, P.a. | |
|
10700 Old County Road 15 Ste 170 Plymouth MN 55441-8709 | |
| (763) 525-8590 | |
| (763) 525-9592 |
| Full Name | Pathways Psychological Services, P.a. |
|---|---|
| Speciality | Counselor |
| Location | 10700 Old County Road 15 Ste 170, Plymouth, Minnesota |
| Authorized Official Name and Position | Savanah E Wimbush (OFFICE MANAGER) |
| Authorized Official Contact | 7635258590 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathways Psychological Services, P.a. 10700 Old County Road 15 Ste 170 Plymouth MN 55441-8709 Ph: (763) 525-8590 | Pathways Psychological Services, P.a. 10700 Old County Road 15 Ste 170 Plymouth MN 55441-8709 Ph: (763) 525-8590 |
| NPI Number | 1366443723 |
|---|---|
| Provider Enumeration Date | 08/09/2005 |
| Last Update Date | 07/01/2023 |
| Certification Date | 07/01/2023 |
| Medicare PECOS PAC ID | 9133161672 |
|---|---|
| Medicare Enrollment ID | O20050525000597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366443723 | NPI | - | NPPES |
| 776781100 | Medicaid | MN | |
| 108992 | Other | MN | UCARE |
| 35674 | Other | MN | HEALTHPARTNERS |
| 8H914PA | Other | MN | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (Minnesota) | Primary |
| Provider Name | Ying P Elliott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144213901 PECOS PAC ID: 1658300157 Enrollment ID: I20050804001075 |
| Provider Name | Christian Lea Babo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003809856 PECOS PAC ID: 3870698475 Enrollment ID: I20070410000205 |
| Provider Name | Sherrill A Lemmermann |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235355884 PECOS PAC ID: 5496810590 Enrollment ID: I20090224000147 |
| Provider Name | Gary D Vikesland |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073506846 PECOS PAC ID: 3779629720 Enrollment ID: I20091006000420 |
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