| Pro Recovery And Therapy | |
|
700 Commerce Dr Ste 245 Woodbury MN 55125-2552 | |
| (651) 204-9144 | |
| (651) 364-7445 |
| Full Name | Pro Recovery And Therapy |
|---|---|
| Speciality | Counselor |
| Location | 700 Commerce Dr Ste 245, Woodbury, Minnesota |
| Authorized Official Name and Position | Lauren Fortman (OWNER) |
| Authorized Official Contact | 6512049144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pro Recovery And Therapy 700 Commerce Dr Ste 245 Woodbury MN 55125-2552 Ph: (651) 204-9144 | Pro Recovery And Therapy 700 Commerce Dr Ste 245 Woodbury MN 55125-2552 Ph: (651) 204-9144 |
| NPI Number | 1639715402 |
|---|---|
| Provider Enumeration Date | 11/26/2019 |
| Last Update Date | 03/19/2024 |
| Certification Date | 03/19/2024 |
| Medicare PECOS PAC ID | 0840635215 |
|---|---|
| Medicare Enrollment ID | O20240226003105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639715402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Lauren Fortman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811366891 PECOS PAC ID: 2961849757 Enrollment ID: I20240328003193 |
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