Provider Demographics
NPI:1861239733
Name:CALMCARE PSYCHIATRY CLINIC S.C.
Entity type:Organization
Organization Name:CALMCARE PSYCHIATRY CLINIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHNP
Authorized Official - Prefix:
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:KOU
Authorized Official - Last Name:GEHYIGON-WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,APRN,CNP
Authorized Official - Phone:763-913-8125
Mailing Address - Street 1:2219 OAKLAND AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2219 OAKLAND AVE STE 111
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3706
Practice Address - Country:US
Practice Address - Phone:612-208-3593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center