NPIMap

Organization Active NPI

Psychotherapeutic Resources LLP

  • Adult Mental Health Clinic/Center
  • Saint Cloud, MN
National Provider Identifier
1619059755
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
PSYCHOTHERAPEUTIC RESOURCES LLP
Practice address
1411 W Saint Germain St Ste 105
Saint Cloud, MN 56301-4121
Phone
(320) 253-3715
Fax
(320) 252-2567
NPI assigned
Oct 19, 2006
Last updated
May 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Authorized official

Name
Sara ShostedNPI 1255577482
Title
Owner
Phone
(320) 253-3715

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

1411 W Saint Germain St Ste 105
Saint Cloud, MN 56301-4121

Mailing address

1411 W Saint Germain St Ste 105
Saint Cloud, MN 56301-4180
Phone (320) 253-3715

Other practice location 1

9447 Stillwater Blvd N
Lake Elmo, MN 55042-9405
Phone (320) 253-3715

Other identifiers 1

IdentifierTypeStateIssuer
683752200MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050124000980 MN Part B Supplier - Clinic/Group Practice 3678523008 Receives reassigned benefits from 5 practitioners
Practice locations: Saint Cloud, MN

National Provider Directory

National Provider Directory

Locations

1411 W Saint Germain St
Ste 105
Saint Cloud, MN 56301
Phone (320) 253-3715

325 33rd Ave N
Ste 103
Saint Cloud, MN 56303
Phone (320) 253-3715

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1619059755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 W SAINT GERMAIN ST STE 105",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014180",
            "telephone_number": "320-253-3715",
            "fax_number": "320-252-2567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 W SAINT GERMAIN ST STE 105",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014121",
            "telephone_number": "320-253-3715",
            "fax_number": "320-252-2567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9447 Stillwater Blvd N",
            "address_purpose": "LOCATION",
            "city": "Lake Elmo",
            "state": "MN",
            "postal_code": "550429405",
            "country_code": "US",
            "telephone_number": "320-253-3715",
            "fax_number": "320-252-2567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSYCHOTHERAPEUTIC RESOURCES LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "SHOSTED",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-253-3715"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "683752200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.