| Manes For Change Llc | |
|
1884 Mahogany St Mora MN 55051-7111 | |
| (320) 339-9963 | |
| (320) 348-7257 |
| Full Name | Manes For Change Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1884 Mahogany St, Mora, Minnesota |
| Authorized Official Name and Position | Jamie Rose Bankers (OWNER / CLINICAL THERAPIST) |
| Authorized Official Contact | 3203399963 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Manes For Change Llc 1884 Mahogany St Mora MN 55051-7111 Ph: (320) 339-9963 | Manes For Change Llc 1884 Mahogany St Mora MN 55051-7111 Ph: (320) 339-9963 |
| NPI Number | 1336721364 |
|---|---|
| Provider Enumeration Date | 04/28/2021 |
| Last Update Date | 04/28/2021 |
| Certification Date | 04/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336721364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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