| Crescent Moon Counseling | |
|
9708 Highway 22 Angora MN 55703-8210 | |
| (610) 507-0051 | |
| Not Available |
| Full Name | Crescent Moon Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 9708 Highway 22, Angora, Minnesota |
| Authorized Official Name and Position | Lauren M Simensen (MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 6105070051 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crescent Moon Counseling 9708 Highway 22 Angora MN 55703-8210 Ph: (610) 507-0051 | Crescent Moon Counseling 9708 Highway 22 Angora MN 55703-8210 Ph: (610) 507-0051 |
| NPI Number | 1881328482 |
|---|---|
| Provider Enumeration Date | 07/11/2022 |
| Last Update Date | 07/11/2022 |
| Certification Date | 07/11/2022 |
| Medicare PECOS PAC ID | 3476920646 |
|---|---|
| Medicare Enrollment ID | O20221031002493 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881328482 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lauren M Simensen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366968281 PECOS PAC ID: 0749546919 Enrollment ID: I20171106000678 |
| Provider Name | Tatiana Rivera Cruz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881343051 PECOS PAC ID: 3476921206 Enrollment ID: I20230908000473 |