| Pride Counseling Services Pllc | |
|
110 E Walnut St Mankato MN 56001-3655 | |
| (507) 246-2667 | |
| (507) 514-0999 |
| Full Name | Pride Counseling Services Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 110 E Walnut St, Mankato, Minnesota |
| Authorized Official Name and Position | Jennifer O Kolstad (OWNER) |
| Authorized Official Contact | 5072462667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pride Counseling Services Pllc 110 E Walnut St Mankato MN 56001-3655 Ph: (507) 246-2667 | Pride Counseling Services Pllc 110 E Walnut St Mankato MN 56001-3655 Ph: (507) 246-2667 |
| NPI Number | 1417548587 |
|---|---|
| Provider Enumeration Date | 02/01/2021 |
| Last Update Date | 11/21/2023 |
| Certification Date | 11/21/2023 |
| Medicare PECOS PAC ID | 5092100842 |
|---|---|
| Medicare Enrollment ID | O20220315001315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417548587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jennifer Oline Kolstad |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336647106 PECOS PAC ID: 7719372564 Enrollment ID: I20220315001440 |
| Provider Name | Gykayla Quinn Curtis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790368256 PECOS PAC ID: 8820449424 Enrollment ID: I20240108005803 |
| Provider Name | Amy Burkholder |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851784722 PECOS PAC ID: 5092167353 Enrollment ID: I20240123000879 |
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