| Mangata Counseling Services Llc | |
|
510 1st St N Ste B New Ulm MN 56073-1771 | |
| (507) 276-7703 | |
| Not Available |
| Full Name | Mangata Counseling Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 510 1st St N Ste B, New Ulm, Minnesota |
| Authorized Official Name and Position | Danielle Marie Fischer Marti (OWNER) |
| Authorized Official Contact | 5072767703 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mangata Counseling Services Llc 49294 239th Ave Lake Crystal MN 56055-2315 Ph: (507) 276-7703 | Mangata Counseling Services Llc 510 1st St N Ste B New Ulm MN 56073-1771 Ph: (507) 276-7703 |
| NPI Number | 1811527898 |
|---|---|
| Provider Enumeration Date | 01/18/2020 |
| Last Update Date | 03/10/2020 |
| Certification Date | 03/10/2020 |
| Medicare PECOS PAC ID | 8022449602 |
|---|---|
| Medicare Enrollment ID | O20200514002272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811527898 | NPI | - | NPPES |
| 1790091452 | Medicaid | MN | |
| 14122708 | Other | MN | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Danielle Marie F Marti |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790091452 PECOS PAC ID: 5698927028 Enrollment ID: I20121212000169 |
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