Provider Demographics
NPI:1538541347
Name:PREGNANCY AND POSTPARTUM SUPPORT MINNESOTA
Entity type:Organization
Organization Name:PREGNANCY AND POSTPARTUM SUPPORT MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR OF PPSM
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:612-548-4266
Mailing Address - Street 1:1700 NIAGARA LN N
Mailing Address - Street 2:STE 201
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4739
Mailing Address - Country:US
Mailing Address - Phone:612-590-7794
Mailing Address - Fax:
Practice Address - Street 1:1700 NIAGARA LN N
Practice Address - Street 2:STE 201
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4739
Practice Address - Country:US
Practice Address - Phone:612-590-7794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAMI MINNESOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty