Peacetree Family Institute LTD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

PEACETREE FAMILY INSTITUTE LTD

Practice address

10741 185TH Cir NW
Elk River, MN 55330-5032

Phone

(612) 203-0849

NPI assigned

May 15, 2023

Organization subpart

No

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

Authorized official

Name

Melissa NikovicsNPI 1336791995

Title

Owner

Phone

(612) 203-0849

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Melissa Lou Nikovics

  • Mental Health Counselor
  • Otsego, MN
  • NPI 1336791995
  Medicare reassignment NPD Authorized official
• Tyler Antony

  • Professional Counselor
  • Elk River, MN
  • NPI 1134998552
  NPD
• Ronda Marie Disch

  • Mental Health Counselor
  • Elk River, MN
  • NPI 1861893505
  NPD
• Kelli Jo Higgins

  • Mental Health Counselor
  • Otsego, MN
  • NPI 1073387247
  NPD
• Heather Jean Roberts, LPC

  • Mental Health Counselor
  • Elk River, MN
  • NPI 1124553565
  NPD
• Jennifer Weigelt, LP

  • Clinical Psychologist
  • Otsego, MN
  • NPI 1053690297

  Professional

  NPD
• Nycole Lynn Wiek, MSW, LGSW

  • Clinical Social Worker
  • Elk River, MN
  • NPI 1184381055
  NPD
• Crystal Rivers, PHD, LP

  • Clinical Neuropsychologist
  • Urbandale, IA
  • NPI 1437748266
  NPD
• Andrew A Chisel

  • Mental Health Counselor
  • Elk River, MN
  • NPI 1144151473
  NPD (past)
• Amber Martina Lindeman, PSYD, LP

  • Clinical Psychologist
  • South St Paul, MN
  • NPI 1841510567
  NPD (past)
• Alison M. Smetana, LICSW

  • Clinical Social Worker
  • Elk River, MN
  • NPI 1770064925
  NPD (past)

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1053002881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10741 185TH CIR NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553305032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10741 185TH CIR NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553305032",
            "telephone_number": "612-203-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACETREE FAMILY INSTITUTE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-15",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "NIKOVICS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-203-0849"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spencer Daniel Patten
• Kimberly Jane Paulson
• Sara Elizabeth Pauly
• Anna Payne, DC
• PDG, PA
• Carly P Pederson, ATC/R
• Pendo Health Services Inc
• Penneh Issie Home Healthcare
• Rebecca Ann Petersen
• Peterson Family Living

• Clinical Psychologist in Elk River, MN
• Providers in Elk River, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.