Provider Demographics
NPI:1609939388
Name:DIANE STELLRECHT & ASSOC INC
Entity Type:Organization
Organization Name:DIANE STELLRECHT & ASSOC INC
Other - Org Name:STELLRECHT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:STELLRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:651-699-7050
Mailing Address - Street 1:570 ASHBURY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-699-7050
Mailing Address - Fax:651-699-8698
Practice Address - Street 1:570 ASHBURY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-699-7050
Practice Address - Fax:651-699-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1130103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP37858OtherHEALTH PARTNERS
6119335OtherMEDICA
MN28682STOtherBCBS
6119335OtherMEDICA