Healthcare Provider Details

I. General information

NPI: 1891713681
Provider Name (Legal Business Name): PSYCHIATRIC RECOVERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W SUITE 229N
SAINT PAUL MN
55114
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W SUITE 229N
SAINT PAUL MN
55114
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-3115
  • Fax: 651-645-2752
Mailing address:
  • Phone: 651-645-3115
  • Fax: 651-645-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1339
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number1339
License Number StateMN

VIII. Authorized Official

Name: AMY JO CLUTE
Title or Position: OFFICE MANAGER
Credential:
Phone: 651-294-3436