Provider Demographics
NPI:1548534191
Name:STONE CREEK PSYCHIATRY, LLC
Entity type:Organization
Organization Name:STONE CREEK PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WINEGARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MB
Authorized Official - Phone:952-241-4050
Mailing Address - Street 1:7945 STONE CREEK DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4605
Mailing Address - Country:US
Mailing Address - Phone:952-241-4050
Mailing Address - Fax:952-241-4049
Practice Address - Street 1:7945 STONE CREEK DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4605
Practice Address - Country:US
Practice Address - Phone:952-241-4050
Practice Address - Fax:952-241-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty