| The Soul's Apothecary | |
|
10567 165th St W Lakeville MN 55044-3523 | |
| (952) 767-9374 | |
| Not Available |
| Full Name | The Soul's Apothecary |
|---|---|
| Speciality | Psychologist |
| Location | 10567 165th St W, Lakeville, Minnesota |
| Authorized Official Name and Position | Joshua Timothy Mears (OWNER) |
| Authorized Official Contact | 9527679376 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Soul's Apothecary 10567 165th St W Lakeville MN 55044-3523 Ph: (952) 767-9374 | The Soul's Apothecary 10567 165th St W Lakeville MN 55044-3523 Ph: (952) 767-9374 |
| NPI Number | 1881333946 |
|---|---|
| Provider Enumeration Date | 05/27/2022 |
| Last Update Date | 10/31/2022 |
| Certification Date | 10/31/2022 |
| Medicare PECOS PAC ID | 3971971284 |
|---|---|
| Medicare Enrollment ID | O20221117001468 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881333946 | NPI | - | NPPES |
| 1790062438 | Medicaid | MN |
| Provider Name | Joshua T Mears |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790062438 PECOS PAC ID: 4082853866 Enrollment ID: I20130627000346 |
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