| Harvodes Bereavement And Loss Center, Inc | |
|
2700 1st St N Ste 103 Saint Cloud MN 56303-4202 | |
| (320) 259-7706 | |
| (320) 251-4590 |
| Full Name | Harvodes Bereavement And Loss Center, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 2700 1st St N Ste 103, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Billy Anderson (FOUNDER/MENTAL HEALTH CLINICAN) |
| Authorized Official Contact | 3202597706 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Harvodes Bereavement And Loss Center, Inc 2700 1st St N Ste 103 Saint Cloud MN 56303-4202 Ph: (320) 259-7706 | Harvodes Bereavement And Loss Center, Inc 2700 1st St N Ste 103 Saint Cloud MN 56303-4202 Ph: (320) 259-7706 |
| NPI Number | 1053569798 |
|---|---|
| Provider Enumeration Date | 09/07/2008 |
| Last Update Date | 06/17/2022 |
| Certification Date | 06/17/2022 |
| Medicare PECOS PAC ID | 0042697559 |
|---|---|
| Medicare Enrollment ID | O20220520002092 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053569798 | NPI | - | NPPES |
| 347720700 | Other | MN | MEDICAL ASSISTANCE/MINNESOTA CARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 300215 (Minnesota) | Secondary |
| 1041C0700X | Social Worker - Clinical | 12688 (Minnesota) | Primary |
| Provider Name | Billy Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033286414 PECOS PAC ID: 1052720166 Enrollment ID: I20210430001892 |
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