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5878 Blackshire Path Inver Grove Heights MN 55076-1621 | |
| (651) 276-2385 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 5878 Blackshire Path, Inver Grove Heights, Minnesota |
| Authorized Official Name and Position | Pegann Marie Truax (OWNER/CLINICIAN) |
| Authorized Official Contact | 6512762385 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5878 Blackshire Path Inver Grove Heights MN 55076-1621 Ph: (651) 276-2385 | 5878 Blackshire Path Inver Grove Heights MN 55076-1621 Ph: (651) 276-2385 |
| NPI Number | 1699176602 |
|---|---|
| Provider Enumeration Date | 09/09/2014 |
| Last Update Date | 09/05/2024 |
| Certification Date | 09/05/2024 |
| Medicare PECOS PAC ID | 2062948672 |
|---|---|
| Medicare Enrollment ID | O20241205003962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699176602 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 00816 (Minnesota) | Primary |
| Provider Name | Pegann Marie Truax |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467702076 PECOS PAC ID: 8325574932 Enrollment ID: I20241205004068 |
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