| Hiraeth Psychotherapy Pllc | |
|
4749 Chicago Ave Ste 2b Minneapolis MN 55407-4181 | |
| (612) 404-0211 | |
| Not Available |
| Full Name | Hiraeth Psychotherapy Pllc |
|---|---|
| Speciality | Counselor |
| Location | 4749 Chicago Ave Ste 2b, Minneapolis, Minnesota |
| Authorized Official Name and Position | Laura Marie Ford (OWNER) |
| Authorized Official Contact | 6124040211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hiraeth Psychotherapy Pllc 4749 Chicago Ave Ste 2b Minneapolis MN 55407-4181 Ph: (612) 404-0211 | Hiraeth Psychotherapy Pllc 4749 Chicago Ave Ste 2b Minneapolis MN 55407-4181 Ph: (612) 404-0211 |
| NPI Number | 1780175182 |
|---|---|
| Provider Enumeration Date | 05/22/2018 |
| Last Update Date | 02/29/2024 |
| Certification Date | 02/29/2024 |
| Medicare PECOS PAC ID | 0143764514 |
|---|---|
| Medicare Enrollment ID | O20240627000690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780175182 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 1805 (Minnesota) | Primary |
| Provider Name | Laura Marie Ford |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518479138 PECOS PAC ID: 1052855426 Enrollment ID: I20240627000750 |
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