| Acres For Life Therapy & Wellness Center | |
|
11720 256th St Chisago City MN 55013-9752 | |
| (651) 257-4159 | |
| Not Available |
| Full Name | Acres For Life Therapy & Wellness Center |
|---|---|
| Speciality | Counselor |
| Location | 11720 256th St, Chisago City, Minnesota |
| Authorized Official Name and Position | Lynn Marie Moore (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6512574159 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Acres For Life Therapy & Wellness Center 11720 256th St Chisago City MN 55013-9752 Ph: (651) 257-4159 | Acres For Life Therapy & Wellness Center 11720 256th St Chisago City MN 55013-9752 Ph: (651) 257-4159 |
| NPI Number | 1053702910 |
|---|---|
| Provider Enumeration Date | 02/13/2015 |
| Last Update Date | 02/13/2015 |
| Medicare PECOS PAC ID | 3173983038 |
|---|---|
| Medicare Enrollment ID | O20230724003484 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053702910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 302220 (Minnesota) | Primary |
| Provider Name | Jennifer Ann Itskovich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427265255 PECOS PAC ID: 8123488095 Enrollment ID: I20230724003723 |
| Provider Name | Erica Rae Cournoyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144957143 PECOS PAC ID: 4385006097 Enrollment ID: I20230811002803 |
| Provider Name | Heather Marie Jeffrey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366132870 PECOS PAC ID: 3678923067 Enrollment ID: I20231227002435 |
| Provider Name | Elizabeth Bester Mihalchick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134666381 PECOS PAC ID: 5890237903 Enrollment ID: I20240604004030 |
Minerva Center For Psychology Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 11185 Lake Blvd Ste 205, Chisago City, MN 55013 Phone: 612-865-9150 | |
Family Based Therapy Associates Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11549 Lake Ln, Suite 2, Chisago City, MN 55013 Phone: 651-257-2733 Fax: 651-257-2783 |