| Life In Color Psychotherapy Llc | |
|
2136 Ford Pkwy # 9149 Saint Paul MN 55116-2850 | |
| (952) 457-7139 | |
| Not Available |
| Full Name | Life In Color Psychotherapy Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2136 Ford Pkwy # 9149, Saint Paul, Minnesota |
| Authorized Official Name and Position | Denise Bloczynski Rodiles (THERAPIST) |
| Authorized Official Contact | 9524577139 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life In Color Psychotherapy Llc 2435 Virginia Cir Roseville MN 55113-3621 Ph: (952) 457-7139 | Life In Color Psychotherapy Llc 2136 Ford Pkwy # 9149 Saint Paul MN 55116-2850 Ph: (952) 457-7139 |
| NPI Number | 1245054972 |
|---|---|
| Provider Enumeration Date | 11/11/2024 |
| Last Update Date | 11/11/2024 |
| Certification Date | 11/10/2024 |
| Medicare PECOS PAC ID | 7911427760 |
|---|---|
| Medicare Enrollment ID | O20250224001250 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245054972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Denise B Rodiles |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1265084735 PECOS PAC ID: 2264879022 Enrollment ID: I20240328001922 |
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