| Peacetree Family Institute Ltd | |
|
10741 185th Cir Nw Elk River MN 55330-5032 | |
| (612) 203-0849 | |
| Not Available |
| Full Name | Peacetree Family Institute Ltd |
|---|---|
| Speciality | Psychologist |
| Location | 10741 185th Cir Nw, Elk River, Minnesota |
| Authorized Official Name and Position | Melissa Nikovics (OWNER) |
| Authorized Official Contact | 6122030849 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peacetree Family Institute Ltd 10741 185th Cir Nw Elk River MN 55330-5032 Ph: () - | Peacetree Family Institute Ltd 10741 185th Cir Nw Elk River MN 55330-5032 Ph: (612) 203-0849 |
| NPI Number | 1053002881 |
|---|---|
| Provider Enumeration Date | 05/15/2023 |
| Last Update Date | 01/09/2024 |
| Certification Date | 01/09/2024 |
| Medicare PECOS PAC ID | 9436594082 |
|---|---|
| Medicare Enrollment ID | O20240305002409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053002881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Melissa Lou Nikovics |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336791995 PECOS PAC ID: 9436500188 Enrollment ID: I20240108003616 |
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