Provider Demographics
NPI: | 1881849586 |
---|---|
Name: | ST. CROIX PSYCHIATRIC, LLC |
Entity Type: | Organization |
Organization Name: | ST. CROIX PSYCHIATRIC, LLC |
Other - Org Name: | PRAIRIECARE MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | STEPHEN |
Authorized Official - Middle Name: | ROGER |
Authorized Official - Last Name: | SETTERBERG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 651-259-9707 |
Mailing Address - Street 1: | 7616 CURRELL BLVD |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | WOODBURY |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55125-2290 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-259-9700 |
Mailing Address - Fax: | 651-259-9730 |
Practice Address - Street 1: | 7616 CURRELL BLVD |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | WOODBURY |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55125-2290 |
Practice Address - Country: | US |
Practice Address - Phone: | 651-259-9700 |
Practice Address - Fax: | 651-259-9730 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-11-21 |
Last Update Date: | 2009-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 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 | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 163WP0809X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
No | 283Q00000X | Hospitals | Psychiatric Hospital | Group - Multi-Specialty | |
No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |