| Sumus Health, Llc | |
|
6020 302nd St Stacy MN 55079-9649 | |
| (612) 418-9391 | |
| Not Available |
| Full Name | Sumus Health, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 6020 302nd St, Stacy, Minnesota |
| Authorized Official Name and Position | Richard Anthony Blackburn (CO-OWNER) |
| Authorized Official Contact | 6124189391 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sumus Health, Llc 6020 302nd St Stacy MN 55079-9649 Ph: (612) 418-9391 | Sumus Health, Llc 6020 302nd St Stacy MN 55079-9649 Ph: (612) 418-9391 |
| NPI Number | 1053991448 |
|---|---|
| Provider Enumeration Date | 04/10/2021 |
| Last Update Date | 04/10/2021 |
| Certification Date | 04/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053991448 | NPI | - | NPPES |
| 1134293400 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
Bourdeaux Psychological Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4425 311th St, Stacy, MN 55079 Phone: 612-326-0775 Fax: 161-243-5411 |