| Life Interrupted Counseling Services | |
|
1500 Mcandrews Rd W Ste 215 Burnsville MN 55337-4445 | |
| (952) 222-3002 | |
| Not Available |
| Full Name | Life Interrupted Counseling Services |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1500 Mcandrews Rd W Ste 215, Burnsville, Minnesota |
| Authorized Official Name and Position | Mary L Chedda (CEO/SOLE PROPRIETOR) |
| Authorized Official Contact | 6513388643 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Interrupted Counseling Services 1500 Mcandrews Rd W Ste 215 Burnsville MN 55337-4445 Ph: (651) 338-8643 | Life Interrupted Counseling Services 1500 Mcandrews Rd W Ste 215 Burnsville MN 55337-4445 Ph: (952) 222-3002 |
| NPI Number | 1033821632 |
|---|---|
| Provider Enumeration Date | 12/15/2022 |
| Last Update Date | 01/18/2024 |
| Certification Date | 01/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033821632 | NPI | - | NPPES |
| 1861931966 | Other | MN | INDIVIDUAL NPI |
| 1861931966 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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