| Leah Vancura Therapeutic Services, Llc | |
|
11670 Fountains Dr Ste 200 Maple Grove MN 55369-7195 | |
| (612) 355-0693 | |
| Not Available |
| Full Name | Leah Vancura Therapeutic Services, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 11670 Fountains Dr Ste 200, Maple Grove, Minnesota |
| Authorized Official Name and Position | Leah Vancura (OWNER) |
| Authorized Official Contact | 6123550693 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leah Vancura Therapeutic Services, Llc 9553 Lancaster Ln Maple Grove MN 55369-7569 Ph: (612) 355-0693 | Leah Vancura Therapeutic Services, Llc 11670 Fountains Dr Ste 200 Maple Grove MN 55369-7195 Ph: (612) 355-0693 |
| NPI Number | 1003692484 |
|---|---|
| Provider Enumeration Date | 09/01/2023 |
| Last Update Date | 09/01/2023 |
| Certification Date | 08/31/2023 |
| Medicare PECOS PAC ID | 6608210380 |
|---|---|
| Medicare Enrollment ID | O20240221002449 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003692484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Leah M Vancura |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1477194959 PECOS PAC ID: 7214371905 Enrollment ID: I20240221002587 |
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