Healthcare Provider Details

I. General information

NPI: 1760136964
Provider Name (Legal Business Name): PSYCH NORTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E CENTRAL ENTRANCE
DULUTH MN
55811-5501
US

IV. Provider business mailing address

2854 HIGHWAY 55 STE 130
EAGAN MN
55121-1776
US

V. Phone/Fax

Practice location:
  • Phone: 218-209-2150
  • Fax: 833-903-0315
Mailing address:
  • Phone: 651-842-3349
  • Fax: 651-842-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICK BAILEY
Title or Position: CO-OWNER
Credential:
Phone: 218-209-2150