| Professional Counseling & Grief Services Inc | |
|
14985 Glazier Ave Suite 555 Apple Valley MN 55124-7484 | |
| (952) 891-2525 | |
| (952) 891-1800 |
| Full Name | Professional Counseling & Grief Services Inc |
|---|---|
| Speciality | Social Worker |
| Location | 14985 Glazier Ave, Apple Valley, Minnesota |
| Authorized Official Name and Position | Brenda J Demotte (OWNER/PROVIDER) |
| Authorized Official Contact | 9528912525 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Counseling & Grief Services Inc 14985 Glazier Ave Suite 555 Apple Valley MN 55124-7484 Ph: (952) 891-2525 | Professional Counseling & Grief Services Inc 14985 Glazier Ave Suite 555 Apple Valley MN 55124-7484 Ph: (952) 891-2525 |
| NPI Number | 1508174681 |
|---|---|
| Provider Enumeration Date | 09/22/2010 |
| Last Update Date | 12/21/2010 |
| Medicare PECOS PAC ID | 3577749555 |
|---|---|
| Medicare Enrollment ID | O20110510000304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508174681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 05559 (Minnesota) | Primary |
| Provider Name | Brenda J Demotte |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144307471 PECOS PAC ID: 2365628344 Enrollment ID: I20110510000332 |
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