Complementary Support Services

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

08879 Issued in MN

Legal business name

COMPLEMENTARY SUPPORT SERVICES

Practice address

6701 Penn Ave S
Suite #301
Richfield, MN 55423-2093

Phone

(952) 608-8403

Fax

(612) 861-7589

NPI assigned

Dec 8, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Teri Dawn Dimond, LICSW

Title

Executive Director

Phone

(952) 608-8403

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Tax ID family

Clinical Support Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Complementary Support Services

  • Community/Behavioral Health Agency
  • Chanhassen, MN
  • NPI 1497077796
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023093473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 PENN AVENUE S.",
            "address_2": "SUITE #301",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "55423",
            "telephone_number": "952-608-8403",
            "fax_number": "612-861-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 PENN AVE S",
            "address_2": "SUITE #301",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554232093",
            "telephone_number": "952-608-8403",
            "fax_number": "612-861-7589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLEMENTARY SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIMOND",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "952-608-8403",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "08879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Thi Clarkson, DNP
• CLD - Richfield MN, LLC
• Timothy Lamar Coats Jr. Jr.
• Sara M Colarusso, DDS
• Dana Collins, LMT
• Complementary Support Services
• Complete Chiropractic and Wellness, PA
• Context Psychotherapy LLC
• Charnea Cook-Gregory
• Josh Cook, LICSW

• Clinical Social Worker in Richfield, MN
• Providers in Richfield, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.