| Your Story Matters Counseling | |
|
1250 Moore Lake Dr E Ste 205d Fridley MN 55432-5176 | |
| (612) 293-0635 | |
| Not Available |
| Full Name | Your Story Matters Counseling |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1250 Moore Lake Dr E Ste 205d, Fridley, Minnesota |
| Authorized Official Name and Position | Shannon Martina Rapalo Medina (OWNER) |
| Authorized Official Contact | 6122930635 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Story Matters Counseling 1250 Moore Lake Dr E Ste 205d Fridley MN 55432-5176 Ph: (612) 293-0635 | Your Story Matters Counseling 1250 Moore Lake Dr E Ste 205d Fridley MN 55432-5176 Ph: (612) 293-0635 |
| NPI Number | 1396424446 |
|---|---|
| Provider Enumeration Date | 07/17/2023 |
| Last Update Date | 08/22/2023 |
| Certification Date | 08/22/2023 |
| Medicare PECOS PAC ID | 2668826637 |
|---|---|
| Medicare Enrollment ID | O20230925001859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396424446 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Shannon Martina Rapalo Medina |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104531458 PECOS PAC ID: 4486008455 Enrollment ID: I20230925001907 |
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