Provider Demographics
NPI:1164316113
Name:MANATEE MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:MANATEE MENTAL HEALTH, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:763-200-4344
Mailing Address - Street 1:515 1ST AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-7120
Mailing Address - Country:US
Mailing Address - Phone:763-200-4344
Mailing Address - Fax:
Practice Address - Street 1:515 1ST AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-7120
Practice Address - Country:US
Practice Address - Phone:763-200-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1972230845Medicaid