Healthcare Provider Details

I. General information

NPI: 1487558664
Provider Name (Legal Business Name): EFFECTIVE PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 HILLTOP CT
SAINT PAUL MN
55109-2037
US

IV. Provider business mailing address

1265 HILLTOP CT
MAPLEWOOD MN
55109-2037
US

V. Phone/Fax

Practice location:
  • Phone: 651-235-3607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN KIIZA
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: NP
Phone: 651-235-3607