Provider Demographics
NPI:1679563142
Name:MINNEAPOLIS CLINICAL ASSOCIATES IN PSYCHIATRY LTD
Entity Type:Organization
Organization Name:MINNEAPOLIS CLINICAL ASSOCIATES IN PSYCHIATRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-512-1090
Mailing Address - Street 1:2960 WINNETKA AVE N
Mailing Address - Street 2:STE 208
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2853
Mailing Address - Country:US
Mailing Address - Phone:763-512-1090
Mailing Address - Fax:
Practice Address - Street 1:2960 WINNETKA AVE N
Practice Address - Street 2:STE 208
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55427-2853
Practice Address - Country:US
Practice Address - Phone:763-512-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN109039OtherU-CARE MN
MN130512300Medicaid
MN7079249OtherAETNA
MN1814OtherUNITED HEALTHCARE
MN11618OtherBCBS
MN130512300Medicaid