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12404 Old Rockford Rd Plymouth MN 55441-1204 | |
| (612) 234-1505 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 12404 Old Rockford Rd, Plymouth, Minnesota |
| Authorized Official Name and Position | Courtney Breyer (OWNER) |
| Authorized Official Contact | 6122341505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
12404 Old Rockford Rd Plymouth MN 55441-1204 Ph: (612) 234-1505 | 12404 Old Rockford Rd Plymouth MN 55441-1204 Ph: (612) 234-1505 |
| NPI Number | 1720814205 |
|---|---|
| Provider Enumeration Date | 09/11/2024 |
| Last Update Date | 12/02/2024 |
| Certification Date | 12/02/2024 |
| Medicare PECOS PAC ID | 1052846052 |
|---|---|
| Medicare Enrollment ID | O20241127003613 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720814205 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Courtney C Breyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851917728 PECOS PAC ID: 9133571177 Enrollment ID: I20240628000718 |
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