| Jj Counseling Llc | |
|
112 W 1st St Ste 104 Fairmont MN 56031-1744 | |
| (507) 236-0139 | |
| Not Available |
| Full Name | Jj Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 112 W 1st St Ste 104, Fairmont, Minnesota |
| Authorized Official Name and Position | Annmarie E Gibson (OWNER) |
| Authorized Official Contact | 5072362162 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jj Counseling Llc 112 W 1st St Ste 104 Fairmont MN 56031-1744 Ph: (507) 236-0139 | Jj Counseling Llc 112 W 1st St Ste 104 Fairmont MN 56031-1744 Ph: (507) 236-0139 |
| NPI Number | 1962067405 |
|---|---|
| Provider Enumeration Date | 05/09/2019 |
| Last Update Date | 08/24/2020 |
| Certification Date | 08/24/2020 |
| Medicare PECOS PAC ID | 8123446861 |
|---|---|
| Medicare Enrollment ID | O20200914000501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962067405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kristine Marie Shoen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558549907 PECOS PAC ID: 9537232459 Enrollment ID: I20080724000637 |
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