Carver County
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Waconia, MN
NPI 1326049685 · NPPES record last updated Jun 13, 2023
Key facts
- NPI
- 1326049685
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- License
- 800823-3-MHC (MN)
- Legal business name
- CARVER COUNTY
- Practice address
- 540 E 1St St
Waconia, MN 55387-1601 - Phone
- (952) 442-4437
- Fax
- (952) 442-3084
- NPI assigned
- Aug 9, 2005
- Organization subpart
- No
Authorized official
- Name
- Heather Goodwin
- Title
- Director
- Phone
- (952) 361-1660
Corporate family (same tax ID) 2
Practitioners 60
-
Connie J Gibson, MSSW LICSW
-
Katherine Kerr Jonas, LICSW
-
Sharon Lisa Letizio, MSW LICSW
-
Erin L Martin, PH.D.
-
Michelle L Purtle, PSYD LP
-
Scott Allen Winker, LICSW
-
Florence Alao, PMHNP
-
Amber E Michels, MS, LPCC
-
Jason Gregory Thymian, LICSW
-
Melanie Jane Warm, LICSW
-
Lori Jean Wegner, MSW, LICSW
-
Sonia Ike, PMHNP-BC
-
Melissa Beth Hanson, MSW LICSW
-
Cynthia Barfknecht, LMFT
-
Emily Bennett, LPC
-
Tracy M Davis, LMFT
-
Anthony James Mielke, MA, LMFT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040609000094 | MN | Part B Supplier - Clinic/Group Practice | 8527041961 |
Receives reassigned benefits from 17 practitioners Practice locations: Waconia, MN |
National Provider Directory
- Tax ID family
- Carver County Courthouse
Locations
303 E 6th St
Chaska, MN 55318
Phone (612) 280-5075
540 E 1st St
Waconia, MN 55387
Phone (952) 442-4437
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 800823-3-MHC | MN | Yes |
Addresses
Primary practice location
540 E 1St St
Waconia, MN 55387-1601
Mailing address
540 E 1St St
Waconia, MN 55387-1601
Phone (952) 442-4437
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 328T1BE | Other | MN | BEHAVIORAL HEALTHCARE PRO |
| 109639 | Other | MN | U-CARE |
| 51057CA | Other | MN | BLUE CROSS BLUE SHIELD |
| 924555300 | Medicaid | MN | |
| 1017120 | Other | MN | PREFERRED ONE |
| 31377 | Other | MN | HEALTH PARTNERS |
| 9212210 | Other | MN | METROPOLITAN HEALTH PLAN |
Other names
- Carver County Mental Health
- First Street Center
Other providers in Waconia, MN
- Laura Butler
- Jennifer Cantin
- Sarah Elizabeth Carlson
- Catherine Gayle Carrabre
- Brittany Rose Carstens
- Sarah Case
- Lisa Chapman
- Baylee Chappell
- Nicole J Charles
- Allison Cheesebrow
All providers in Waconia, MN · Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.