| Renew Your Mind - Counseling Consulting And Supervision Llc | |
|
15561 Railroad St Ste 203a Hayward WI 54843-5703 | |
| (651) 347-1380 | |
| Not Available |
| Full Name | Renew Your Mind - Counseling Consulting And Supervision Llc |
|---|---|
| Speciality | Counselor |
| Location | 15561 Railroad St Ste 203a, Hayward, Wisconsin |
| Authorized Official Name and Position | Lesley M Boozell (CREDENTIAL SPECIALIST) |
| Authorized Official Contact | 2182320856 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Your Mind - Counseling Consulting And Supervision Llc 9705n Violet Ln Hayward WI 54843-1179 Ph: (651) 380-2235 | Renew Your Mind - Counseling Consulting And Supervision Llc 15561 Railroad St Ste 203a Hayward WI 54843-5703 Ph: (651) 347-1380 |
| NPI Number | 1699278283 |
|---|---|
| Provider Enumeration Date | 03/09/2018 |
| Last Update Date | 05/16/2024 |
| Certification Date | 05/16/2024 |
| Medicare PECOS PAC ID | 4880036714 |
|---|---|
| Medicare Enrollment ID | O20240523002941 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699278283 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 302869 (Minnesota) | Secondary |
| 101YP2500X | Counselor - Professional | CC01151 (Minnesota) | Primary |
| Provider Name | Annette M Pullen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821338765 PECOS PAC ID: 2961844808 Enrollment ID: I20240523003094 |
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