Healthcare Provider Details

I. General information

NPI: 1619059755
Provider Name (Legal Business Name): PSYCHOTHERAPEUTIC RESOURCES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W SAINT GERMAIN ST STE 105
SAINT CLOUD MN
56301-4121
US

IV. Provider business mailing address

1411 W SAINT GERMAIN ST STE 105
SAINT CLOUD MN
56301-4180
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-3715
  • Fax: 320-252-2567
Mailing address:
  • Phone: 320-253-3715
  • Fax: 320-252-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARA SHOSTED
Title or Position: OWNER
Credential:
Phone: 320-253-3715