| Bamboo Counseling Services Pllc | |
|
12295 Lake Blvd Lindstrom MN 55045-9325 | |
| (651) 243-8967 | |
| Not Available |
| Full Name | Bamboo Counseling Services Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 12295 Lake Blvd, Lindstrom, Minnesota |
| Authorized Official Name and Position | Regina Hollibush (OUTPATIENT MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 6512438967 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bamboo Counseling Services Pllc 12295 Lake Blvd Lindstrom MN 55045-9325 Ph: (651) 243-8967 | Bamboo Counseling Services Pllc 12295 Lake Blvd Lindstrom MN 55045-9325 Ph: (651) 243-8967 |
| NPI Number | 1437691128 |
|---|---|
| Provider Enumeration Date | 11/10/2016 |
| Last Update Date | 11/10/2016 |
| Medicare PECOS PAC ID | 5496036683 |
|---|---|
| Medicare Enrollment ID | O20161230000725 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437691128 | NPI | - | NPPES |
| 1396910022 | Medicaid | MN | |
| 800002086 | Other | MN | MEDICARE NUMBER; NOT SURE WHICH IDENTIFIER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 18910 (Minnesota) | Primary |
| 251S00000X | Community/behavioral Health | 6925 (Wisconsin) | Secondary |
| Provider Name | Regina A Hollibush |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396910022 PECOS PAC ID: 6901978899 Enrollment ID: I20080709000714 |
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