| Penticoff Community Counseling, Inc. | |
|
1818 Wooddale Dr Ste 204 Woodbury MN 55125-2983 | |
| (651) 255-6678 | |
| (651) 501-6091 |
| Full Name | Penticoff Community Counseling, Inc. |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1818 Wooddale Dr Ste 204, Woodbury, Minnesota |
| Authorized Official Name and Position | Renee Marie Penticoff (OWNER, PRESIDENT) |
| Authorized Official Contact | 6512556678 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Penticoff Community Counseling, Inc. Po Box 25334 Woodbury MN 55125-0334 Ph: (651) 255-6678 | Penticoff Community Counseling, Inc. 1818 Wooddale Dr Ste 204 Woodbury MN 55125-2983 Ph: (651) 255-6678 |
| NPI Number | 1588896310 |
|---|---|
| Provider Enumeration Date | 08/12/2009 |
| Last Update Date | 08/12/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588896310 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP-4060 (Minnesota) | Primary |
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