NPIMap

Organization Active NPI

Ellison Center

  • Marriage & Family Therapist
  • Saint Cloud, MN
National Provider Identifier
1740744242
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
ELLISON CENTER
Practice address
600 25TH Ave S Ste 102
Saint Cloud, MN 56301-4820
Phone
(320) 406-1600
Fax
(320) 406-1700
NPI assigned
Jan 29, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Authorized official

Name
Theresa J Schreifels, MS LMFT IMH-ENPI 1720327364
Title
Therapist
Phone
(320) 406-1600

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

600 25TH Ave S Ste 102
Saint Cloud, MN 56301-4820

Mailing address

600 25TH Ave S Ste 102
Saint Cloud, MN 56301-4820
Phone (320) 406-1600

Other identifiers 1

IdentifierTypeStateIssuer
1740744242MedicaidMN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tracy@developmentalimpactllc.com
CONNECT URL tracy@ellisoncenter.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210311001264 MN Part B Supplier - Clinic/Group Practice 4688080989 Receives reassigned benefits from 8 practitioners
Practice locations: Saint Cloud, MN

National Provider Directory

National Provider Directory

Locations

600 25th Ave S
Ste 102
Saint Cloud, MN 56301
Phone (320) 310-6365

720 8th Ave N
Saint Cloud, MN 56303
Phone (320) 333-9228

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604534400000",
    "number": "1740744242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 25TH AVE S STE 102",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014820",
            "telephone_number": "320-406-1600",
            "fax_number": "320-406-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 25TH AVE S STE 102",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014820",
            "telephone_number": "320-406-1600",
            "fax_number": "320-406-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLISON CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-29",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A",
        "authorized_official_last_name": "SCHREIFELS",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "320-406-1600",
        "authorized_official_credential": "MS LMFT IMH-E"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740744242",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tracy@developmentalimpactllc.com",
            "affiliation": "N",
            "endpointDescription": "main office",
            "address_1": "720 8th Ave N",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563033420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "tracy@ellisoncenter.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "600 25th Ave S Ste 102",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563014820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Nov 5, 2020; 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.