| Pure Potential Counseling | |
|
18685 Dylan Dr Farmington MN 55024-7070 | |
| (507) 210-6898 | |
| Not Available |
| Full Name | Pure Potential Counseling |
|---|---|
| Speciality | Psychologist |
| Location | 18685 Dylan Dr, Farmington, Minnesota |
| Authorized Official Name and Position | Katherine Sue Deregnier (LPCC) |
| Authorized Official Contact | 5072106898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Potential Counseling 18685 Dylan Dr Farmington MN 55024-7070 Ph: (507) 210-6898 | Pure Potential Counseling 18685 Dylan Dr Farmington MN 55024-7070 Ph: (507) 210-6898 |
| NPI Number | 1295357440 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 05/11/2020 |
| Certification Date | 05/11/2020 |
| Medicare PECOS PAC ID | 7911426432 |
|---|---|
| Medicare Enrollment ID | O20250528000841 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295357440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Sydney Peters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992279152 PECOS PAC ID: 4587183017 Enrollment ID: I20250528001003 |
| Provider Name | Mary J Anderson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1124405667 PECOS PAC ID: 1557880085 Enrollment ID: I20250528001091 |
| Provider Name | Katherine S Deregnier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679992267 PECOS PAC ID: 8729507256 Enrollment ID: I20250528001203 |
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