Provider Demographics
NPI:1740744242
Name:ELLISON CENTER
Entity Type:Organization
Organization Name:ELLISON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHREIFELS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT IMH-E
Authorized Official - Phone:320-406-1600
Mailing Address - Street 1:600 25TH AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4820
Mailing Address - Country:US
Mailing Address - Phone:320-406-1600
Mailing Address - Fax:320-406-1700
Practice Address - Street 1:600 25TH AVE S STE 102
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4820
Practice Address - Country:US
Practice Address - Phone:320-406-1600
Practice Address - Fax:320-406-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1740744242Medicaid