| Soul Work Counseling, Llc | |
|
11925 Central Ave Ne Blaine MN 55434-3911 | |
| (763) 746-0842 | |
| (763) 208-7297 |
| Full Name | Soul Work Counseling, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11925 Central Ave Ne, Blaine, Minnesota |
| Authorized Official Name and Position | Nancy Petroske (OWNER) |
| Authorized Official Contact | 7637460842 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soul Work Counseling, Llc 11925 Central Ave Ne Blaine MN 55434-3911 Ph: (763) 746-0842 | Soul Work Counseling, Llc 11925 Central Ave Ne Blaine MN 55434-3911 Ph: (763) 746-0842 |
| NPI Number | 1710295001 |
|---|---|
| Provider Enumeration Date | 09/20/2010 |
| Last Update Date | 06/12/2024 |
| Certification Date | 06/12/2024 |
| Medicare PECOS PAC ID | 4789910233 |
|---|---|
| Medicare Enrollment ID | O20190723000039 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710295001 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1604 (Minnesota) | Primary |
| Provider Name | Shawna M Benson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447351812 PECOS PAC ID: 7517914252 Enrollment ID: I20050405000324 |
| Provider Name | Jennifer Lynn Lees |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558430041 PECOS PAC ID: 2769412766 Enrollment ID: I20050819000047 |
| Provider Name | Cynthia White Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962619049 PECOS PAC ID: 3173624772 Enrollment ID: I20070726000565 |
| Provider Name | Terry Riley |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1154601243 PECOS PAC ID: 4385088004 Enrollment ID: I20240221000504 |
| Provider Name | Deborah Mueller |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1366981334 PECOS PAC ID: 5799120424 Enrollment ID: I20240304001880 |
| Provider Name | Janet K Schlegel |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1710081948 PECOS PAC ID: 5698001147 Enrollment ID: I20240515004071 |
| Provider Name | Daniel Connor |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1932339082 PECOS PAC ID: 2769924828 Enrollment ID: I20240605001214 |
| Provider Name | Edi Connor |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1144543570 PECOS PAC ID: 3577005040 Enrollment ID: I20240612001096 |
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