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General NPI Number Information
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NPI Number | 1669901393
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL IMPACT LLC
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 720 8TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-3420
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Country | US
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Telephone | 320-420-2234
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Fax | 320-251-0217
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Provider Business Mailing Address
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Address Line | 720 8TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-3420
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Country | US
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Telephone | 320-420-2234
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Fax | 320-251-0217
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Authorized Official
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Title or Position | CEO
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Name | THERESA SCHREIFELS
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Credential | LMFT
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Telephone | 320-420-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2474
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 2474
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 2474
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License Number State | MN
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