| Vibrant Life Therapy Llc | |
|
2608 Blaisdell Ave Minneapolis MN 55408-5107 | |
| (651) 208-9409 | |
| Not Available |
| Full Name | Vibrant Life Therapy Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2608 Blaisdell Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Tanya Brown (OWNER/THERAPIST) |
| Authorized Official Contact | 6512089409 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vibrant Life Therapy Llc 1189 Brighton Pl Saint Paul MN 55106-1107 Ph: () - | Vibrant Life Therapy Llc 2608 Blaisdell Ave Minneapolis MN 55408-5107 Ph: (651) 208-9409 |
| NPI Number | 1417543877 |
|---|---|
| Provider Enumeration Date | 12/18/2020 |
| Last Update Date | 12/21/2020 |
| Certification Date | 12/21/2020 |
| Medicare PECOS PAC ID | 3274998596 |
|---|---|
| Medicare Enrollment ID | O20230420000739 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417543877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Gao Chee Vang |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992303655 PECOS PAC ID: 0446638787 Enrollment ID: I20220527001546 |
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