Bold North Psychotherapy, Pllc | |
4313 Upton Ave S # 5 Minneapolis MN 55410-1556 | |
(612) 524-9480 | |
Not Available |
Full Name | Bold North Psychotherapy, Pllc |
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Speciality | Counselor |
Location | 4313 Upton Ave S # 5, Minneapolis, Minnesota |
Authorized Official Name and Position | Rachel Herr (CEO) |
Authorized Official Contact | 6123690769 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Bold North Psychotherapy, Pllc 4313 Upton Ave S # 5 Minneapolis MN 55410-1556 Ph: (612) 524-9480 | Bold North Psychotherapy, Pllc 4313 Upton Ave S # 5 Minneapolis MN 55410-1556 Ph: (612) 524-9480 |
NPI Number | 1861105728 |
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Provider Enumeration Date | 01/05/2023 |
Last Update Date | 01/05/2023 |
Certification Date | 01/05/2023 |
Medicare PECOS PAC ID | 4486183498 |
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Medicare Enrollment ID | O20250121001582 |
Identifier | Type | State | Issuer |
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1861105728 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Caileigh E Peters |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1851085641 PECOS PAC ID: 4082076039 Enrollment ID: I20241125002547 |
Provider Name | Rachel Elizabeth Herr |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1952995003 PECOS PAC ID: 3577092592 Enrollment ID: I20250131002393 |
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