| Premiere Mental Health Llc | |
|
360 Sherman St Ste 290 Saint Paul MN 55102-2564 | |
| (763) 913-8125 | |
| Not Available |
| Full Name | Premiere Mental Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 360 Sherman St Ste 290, Saint Paul, Minnesota |
| Authorized Official Name and Position | Princess Kou Gehyigon-wallace (OWNER) |
| Authorized Official Contact | 7639138125 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premiere Mental Health Llc 360 Sherman St Ste 290 Saint Paul MN 55102-2564 Ph: (763) 913-8125 | Premiere Mental Health Llc 360 Sherman St Ste 290 Saint Paul MN 55102-2564 Ph: (763) 913-8125 |
| NPI Number | 1023832938 |
|---|---|
| Provider Enumeration Date | 11/08/2024 |
| Last Update Date | 11/08/2024 |
| Medicare PECOS PAC ID | 2365971512 |
|---|---|
| Medicare Enrollment ID | O20250203000254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023832938 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Princess K Gehyigon-wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275190027 PECOS PAC ID: 4284968991 Enrollment ID: I20190701001256 |
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