Collaborative Psychiatric Services LLC
Organization Active NPI Psychiatry Physician · Oak Park Heights, MN
NPI 1699525857 · NPPES record last updated Mar 25, 2024
Key facts
- NPI
- 1699525857
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- COLLABORATIVE PSYCHIATRIC SERVICES LLC
- Practice address
- 5995 Oren Ave N Ste 203
Oak Park Heights, MN 55082-6379 - Phone
- (651) 504-5103
- NPI assigned
- Mar 22, 2024
- Organization subpart
- No
Authorized official
- Name
- Dr. Justin Gerstner, MD
- Title
- Managing Member
- Phone
- (651) 504-5103
Practitioners 35
-
Justin A. Gerstner, M.D.
-
Kirby Kaczor, LPCC
-
Demi Rose Mancini, LPCC
-
Ashley Lynn Tix, MA
-
Emily Jean Campbell, DNP, APRN, PMHNP-BC
-
Kathryn Mary Conery, LICSW
-
Laura Holton Dabruzzi, LICSW
-
Hedit Florido-Bergad, DNP
-
Ann Marie Monson Slagle, PA-C
-
Lauren Nievinski, PA-C
-
Monsurat Oluwa-Okougbo, NURSE PRACTITIONER
-
Sara Jean Polley, M.D.
-
Amanda Jill Windyk, MSW, LICSW
-
Suzanne Louis Aoun, M.D.
-
Lisa D. Cross, MA, LMFT
-
Sabrina Mae Eller, LPCC
-
Alicia Ann Exsted, MA, LPCC
-
Elizabeth Falk, LICSW
-
Jenna Halvorson, LPCC
-
Hana Hassan, LPCC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240513002614 | MN | Part B Supplier - Clinic/Group Practice | 5496196115 |
Receives reassigned benefits from 4 practitioners Practice locations: Oak Park Heights, MN |
National Provider Directory
Locations
5995 Oren Ave N
Ste 203
Stillwater, MN 55082
Phone (651) 217-1480
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes | ||
| Child & Adolescent Psychiatry Physician |
2084P0804X |
Addresses
Primary practice location
5995 Oren Ave N Ste 203
Oak Park Heights, MN 55082-6379
Mailing address
1406 Hilltop RDG
Houlton, WI 54082-2013
Other providers in Oak Park Heights, MN
- Emily Jean Campbell
- Gregg A Carlton
- Thomas Jason Cesarz
- Chepulis Family Eye Care, Inc.
- Glenn Warren Ciegler
- Kirtley Grace Compton
- Christopher Coulter
- Brittney Cramer
- Mark T Dahl
- Kristen Kingsbury Desautel
All providers in Oak Park Heights, MN · Psychiatry Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2024. 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.