| Brave Soul Counseling Services | |
|
445 Broadway Ave Ste A St Paul Park MN 55071-1554 | |
| (612) 242-1224 | |
| (651) 340-2587 |
| Full Name | Brave Soul Counseling Services |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 445 Broadway Ave Ste A, St Paul Park, Minnesota |
| Authorized Official Name and Position | Jill M. Ellingson (OWNER & CLINICAL DIRECTOR) |
| Authorized Official Contact | 6122421224 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brave Soul Counseling Services 445 Broadway Ave Ste A St Paul Park MN 55071-1554 Ph: (612) 242-1224 | Brave Soul Counseling Services 445 Broadway Ave Ste A St Paul Park MN 55071-1554 Ph: (612) 242-1224 |
| NPI Number | 1457724205 |
|---|---|
| Provider Enumeration Date | 11/02/2015 |
| Last Update Date | 02/10/2020 |
| Certification Date | 02/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457724205 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 2671 (Minnesota) | Primary |
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