| Internal Revolution Counseling And Consulting, L.l.c. | |
|
1123 Grand Avenue Suite 201 Saint Paul MN 55105 | |
| (612) 787-7583 | |
| Not Available |
| Full Name | Internal Revolution Counseling And Consulting, L.l.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1123 Grand Avenue, Saint Paul, Minnesota |
| Authorized Official Name and Position | Anesh Patel (PSYCHOLOGIST) |
| Authorized Official Contact | 6127877583 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Revolution Counseling And Consulting, L.l.c. 3125 37th Ave South Minneapolis MN 55406-2134 Ph: (612) 787-7583 | Internal Revolution Counseling And Consulting, L.l.c. 1123 Grand Avenue Suite 201 Saint Paul MN 55105 Ph: (612) 787-7583 |
| NPI Number | 1679020226 |
|---|---|
| Provider Enumeration Date | 09/01/2016 |
| Last Update Date | 09/01/2016 |
| Medicare PECOS PAC ID | 1456782614 |
|---|---|
| Medicare Enrollment ID | O20200504001977 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679020226 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | LP5711 (Minnesota) | Primary |
| Provider Name | Anesh S Patel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467874495 PECOS PAC ID: 7315177516 Enrollment ID: I20140310001093 |
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