Itasca Psychiatric Services Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

23479 Issued in MN

Legal business name

ITASCA PSYCHIATRIC SERVICES INC

Practice address

25 NE 3Rd St
Grand Rapids, MN 55744-2742

Phone

(218) 327-2284

Fax

(218) 327-3173

NPI assigned

Jul 7, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Bransford, MD

Title

Ceo

Phone

(218) 327-2284

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Ellen S Teigland, MS, APRN, BC, LP

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Grand Rapids, MN
  • NPI 1669401345
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083646327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 NE 3RD ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557442742",
            "telephone_number": "218-327-2284",
            "fax_number": "218-327-3173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 NE 3RD ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557442742",
            "telephone_number": "218-327-2284",
            "fax_number": "218-327-3173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ITASCA PSYCHIATRIC SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRANSFORD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-327-2284",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "23479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Bruce Imholte, M.D.
• Ind School District 318
• Itasca Chiropractic Center, P.C.
• Itasca County Family Young Men's Christian Association, Inc.
• Itasca Nursing Home (Grand Village)
• Itasca Surgical Clinic, PA
• J & L Urevig Inc (Medicine Shoppe)
• J Hill Psychological Services L.L.C
• Brittany Jacobson
• Lana Rae Jacobson, FAMILY NURSE PRACTIT

• Mental Health Clinic/Center (Including Community Mental Health Center) in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.