| Mind Bloom Counseling P.l.l.c. | |
|
215 N Cedar St Ste A Luverne MN 56156-1626 | |
| (507) 608-5979 | |
| (507) 607-8774 |
| Full Name | Mind Bloom Counseling P.l.l.c. |
|---|---|
| Speciality | Counselor |
| Location | 215 N Cedar St Ste A, Luverne, Minnesota |
| Authorized Official Name and Position | Jill Boltjes (OWNER) |
| Authorized Official Contact | 5076085979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Bloom Counseling P.l.l.c. 729 N Cedar St Luverne MN 56156-1318 Ph: (507) 608-5979 | Mind Bloom Counseling P.l.l.c. 215 N Cedar St Ste A Luverne MN 56156-1626 Ph: (507) 608-5979 |
| NPI Number | 1255185658 |
|---|---|
| Provider Enumeration Date | 04/15/2024 |
| Last Update Date | 04/15/2024 |
| Certification Date | 03/28/2024 |
| Medicare PECOS PAC ID | 6901342609 |
|---|---|
| Medicare Enrollment ID | O20240718000142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255185658 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jill G Boltjes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083155881 PECOS PAC ID: 8123467479 Enrollment ID: I20240418003809 |
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