| Psychotherapeutic Resources Llp | |
|
1411 W Saint Germain St Ste 105 Saint Cloud MN 56301-4121 | |
| (320) 253-3715 | |
| (320) 252-2567 |
| Full Name | Psychotherapeutic Resources Llp |
|---|---|
| Speciality | Clinic/Center |
| Location | 1411 W Saint Germain St Ste 105, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Sara Shosted (OWNER) |
| Authorized Official Contact | 3202533715 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychotherapeutic Resources Llp 1411 W Saint Germain St Ste 105 Saint Cloud MN 56301-4180 Ph: (320) 253-3715 | Psychotherapeutic Resources Llp 1411 W Saint Germain St Ste 105 Saint Cloud MN 56301-4121 Ph: (320) 253-3715 |
| NPI Number | 1619059755 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 05/15/2023 |
| Certification Date | 05/15/2023 |
| Medicare PECOS PAC ID | 3678523008 |
|---|---|
| Medicare Enrollment ID | O20050124000980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619059755 | NPI | - | NPPES |
| 683752200 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Stephen S Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013528207 PECOS PAC ID: 0840674008 Enrollment ID: I20220907002197 |
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