Provider Demographics
NPI:1144567546
Name:ST CROIX PSYCHIATRIC SERVICES, PLLC
Entity Type:Organization
Organization Name:ST CROIX PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARALEE
Authorized Official - Middle Name:ANN LUBBERS
Authorized Official - Last Name:LABRECHE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, RN, CNS, CNP
Authorized Official - Phone:612-251-0074
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043-0252
Mailing Address - Country:US
Mailing Address - Phone:612-251-0074
Mailing Address - Fax:855-758-2853
Practice Address - Street 1:700 QUALITY LN N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:MN
Practice Address - Zip Code:55043-9624
Practice Address - Country:US
Practice Address - Phone:612-251-0074
Practice Address - Fax:855-758-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty