|
| |
|
3810 W 31st St Apt 304 Minneapolis MN 55416-5326 | |
| (612) 309-3659 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 3810 W 31st St Apt 304, Minneapolis, Minnesota |
| Authorized Official Name and Position | Camille Weas (OWNER) |
| Authorized Official Contact | 6127905767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8085 Wayzata Blvd Ste 212 Golden Valley MN 55426-1457 Ph: () - | 3810 W 31st St Apt 304 Minneapolis MN 55416-5326 Ph: (612) 309-3659 |
| NPI Number | 1982386777 |
|---|---|
| Provider Enumeration Date | 08/02/2023 |
| Last Update Date | 03/13/2024 |
| Certification Date | 03/13/2024 |
| Medicare PECOS PAC ID | 2567905508 |
|---|---|
| Medicare Enrollment ID | O20240619001203 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982386777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Ingrid Serck-hanssen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457726721 PECOS PAC ID: 3476096413 Enrollment ID: I20240619001248 |
| Provider Name | Camille Faye Weas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770022535 PECOS PAC ID: 2860937000 Enrollment ID: I20240712000683 |
| Provider Name | Krystal Nelson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1245965979 PECOS PAC ID: 4183150915 Enrollment ID: I20241204000483 |
Futurebrain Solutions Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5240 W Lake Nokomis Pkwy, Minneapolis, MN 55417 Phone: 612-378-2363 Fax: 612-378-2363 | |
Phoenix Adolescent Outpatient Treatment Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 13th Ave Se, Minneapolis, MN 55414 Phone: 651-734-3268 Fax: 612-378-4886 | |
1-0 Granny's Helpful Hands, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 705 E Lake St, Minneapolis, MN 55407 Phone: 612-824-1177 | |
Community Empowerment Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Washington Ave N, Minneapolis, MN 55401 Phone: 202-450-0351 | |
The Uptown Center For Psychotherapy Ltd Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3253 Humboldt Ave S, Minneapolis, MN 55408 Phone: 920-277-7923 | |