Provider Demographics
NPI:1740293109
Name:PROCESSUS P.A.
Entity type:Organization
Organization Name:PROCESSUS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEITHER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:320-252-2976
Mailing Address - Street 1:110 2ND ST S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1314
Mailing Address - Country:US
Mailing Address - Phone:320-252-2976
Mailing Address - Fax:320-656-1570
Practice Address - Street 1:110 2ND ST S
Practice Address - Street 2:SUITE 301
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1314
Practice Address - Country:US
Practice Address - Phone:320-252-2976
Practice Address - Fax:320-656-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN804348101YM0800X
101YM0800X, 103TC0700X, 103TC1900X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN001441900Medicaid
MNC02267Medicare ID - Type Unspecified