| Surdy Psychological Services Llc | |
|
1227 Caledonia St Mankato MN 56001-4329 | |
| (507) 388-8874 | |
| (507) 625-4807 |
| Full Name | Surdy Psychological Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1227 Caledonia St, Mankato, Minnesota |
| Authorized Official Name and Position | Theodore Surdy (OWNER) |
| Authorized Official Contact | 5073888874 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Surdy Psychological Services Llc 1227 Caledonia St Mankato MN 56001-4329 Ph: (507) 388-8874 | Surdy Psychological Services Llc 1227 Caledonia St Mankato MN 56001-4329 Ph: (507) 388-8874 |
| NPI Number | 1225576127 |
|---|---|
| Provider Enumeration Date | 02/10/2017 |
| Last Update Date | 03/16/2023 |
| Certification Date | 03/16/2023 |
| Medicare PECOS PAC ID | 6709162811 |
|---|---|
| Medicare Enrollment ID | O20170404000214 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225576127 | NPI | - | NPPES |
| 114945 | Other | MN | UCARE MINNESOTA |
| HP28628 | Other | MN | HEALTH PARTNERS |
| 497823400 | Medicaid | MN | |
| 06T04SU | Other | MN | BXBS |
| 114945 | Other | MN | UNITED |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP3385 (Minnesota) | Primary |
| Provider Name | Theodore M Surdy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063463347 PECOS PAC ID: 5799673505 Enrollment ID: I20070503000476 |
| Provider Name | Robin Gayle Cobbs Min |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497264170 PECOS PAC ID: 2264854074 Enrollment ID: I20200624002856 |
| Provider Name | Steve Lee Larson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659618650 PECOS PAC ID: 6800292616 Enrollment ID: I20210902001019 |
| Provider Name | Taylor M Wester |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912582032 PECOS PAC ID: 6901259605 Enrollment ID: I20240130000832 |
| Provider Name | Theodore Nash Surdy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629663919 PECOS PAC ID: 6709239304 Enrollment ID: I20240131000931 |
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