Organization
CENTER FOR PSYCHIATRIC CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS PETERSON MD (CLINICAL DIRECTOR)
(701) 732-2500
Entity
Organization
Contact information
Practice address
1451 44TH AVE S, UNIT A, GRAND FORKS, ND 58201-3434
(701) 732-2500
(701) 732-2501
Mailing address
1451 44TH AVE S, UNIT A, PO BOX 14545, GRAND FORKS, ND 58201-3434
(701) 732-2500
(701) 732-2501
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
ND
103T00000X
Psychologist
—
ND
1041C0700X
Clinical Social Worker
—
ND
2084P0800X
Psychiatry Physician
Primary
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18009
—
ND
01
—
536318700
MN MEDICAID
MN
01
—
567001
ND BC/BS
ND
Enumeration date
03/31/2006
Last updated
09/02/2016
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