Developmental Impact LLC

Primary specialty

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

License

2474 Issued in MN

Legal business name

DEVELOPMENTAL IMPACT LLC

Practice address

720 8TH Ave N
Saint Cloud, MN 56303-3420

Phone

(320) 420-2234

Fax

(320) 251-0217

NPI assigned

Jun 6, 2017

Organization subpart

No

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

Authorized official

Name

Theresa Schreifels, LMFT

Title

Ceo

Phone

(320) 420-2234

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1669901393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 8TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033420",
            "telephone_number": "320-420-2234",
            "fax_number": "320-251-0217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 8TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033420",
            "telephone_number": "320-420-2234",
            "fax_number": "320-251-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVELOPMENTAL IMPACT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SCHREIFELS",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-420-2234",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "2474",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MN",
            "license": "2474",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": "2474",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720327364",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kylie Danielle Deschane
• Anne Elizabeth Deters, RN
• Anne Elizabeth Deters, LPCC
• Jenifer Karen Detert, P.A.
• Sindhu M. Devani, MD
• Sara Devos
• Sara Dezell, R.N.
• Gati Niranjan Dhroove, MBBS
• Heather Diaz, PHARMD
• Kelsey A Diederich, PT

• All providers in Saint Cloud, MN
• 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 Jul 21, 2022; 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.