| Free Your Mind Therapy Llc | |
|
910 E San Martin St Ofc 2 Bolivar MO 65613-2893 | |
| (417) 414-0676 | |
| (844) 222-4909 |
| Full Name | Free Your Mind Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 910 E San Martin St Ofc 2, Bolivar, Missouri |
| Authorized Official Name and Position | Kimberly A Kanna (OWNER/MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 4174140676 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Free Your Mind Therapy Llc 910 E San Martin St Ofc 2 Bolivar MO 65613-2893 Ph: (417) 414-0676 | Free Your Mind Therapy Llc 910 E San Martin St Ofc 2 Bolivar MO 65613-2893 Ph: (417) 414-0676 |
| NPI Number | 1154001469 |
|---|---|
| Provider Enumeration Date | 07/20/2023 |
| Last Update Date | 09/28/2023 |
| Certification Date | 09/28/2023 |
| Medicare PECOS PAC ID | 0143678805 |
|---|---|
| Medicare Enrollment ID | O20231120000696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154001469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kimberly A Kanna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851977953 PECOS PAC ID: 9638536196 Enrollment ID: I20230530000421 |
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