PSYCH RECOVERY, INC.

Provider Demographics

• NPI: 1316189541
• Name: PSYCH RECOVERY, INC.
• Entity Type: Organization
• Organization Name: PSYCH RECOVERY, INC.
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: SARAH
• Authorized Official - Middle Name: ELIZABETH
• Authorized Official - Last Name: ANDERSON
• Authorized Official - Credentials: LICSW
• Authorized Official - Phone: 651-645-3115
• Mailing Address - Street 1: 2550 UNIVERSITY AVE W
• Mailing Address - Street 2: SUITE 229N
• Mailing Address - City: SAINT PAUL
• Mailing Address - State: MN
• Mailing Address - Zip Code: 55114-1052
• Mailing Address - Country: US
• Mailing Address - Phone: 651-645-3115
• Mailing Address - Fax: 651-645-2752
• Practice Address - Street 1: 2550 UNIVERSITY AVE W
• Practice Address - Street 2: SUITE 229N
• Practice Address - City: SAINT PAUL
• Practice Address - State: MN
• Practice Address - Zip Code: 55114-1052
• Practice Address - Country: US
• Practice Address - Phone: 651-645-3115
• Practice Address - Fax: 651-645-2752
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2009-04-02
• Last Update Date: 2010-11-10

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	103TC2200X	Behavioral Health & Social Service Providers	Psychologist	Clinical Child & Adolescent	Group - Multi-Specialty
No	103TP2701X	Behavioral Health & Social Service Providers	Psychologist	Group Psychotherapy	Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	106H00000X	Behavioral Health & Social Service Providers	Marriage & Family Therapist		Group - Multi-Specialty
No	2084P0804X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Child & Adolescent Psychiatry	Group - Multi-Specialty
No	2084P0805X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Geriatric Psychiatry	Group - Multi-Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Multi-Specialty
No	364SP0807X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health, Child & Adolescent	Group - Multi-Specialty
No	364SP0809X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health, Adult	Group - Multi-Specialty
No	364SP0813X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health, Geropsychiatric	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MN	DO8695	Other	RAILROAD MEDICARE GA