| Sequel Mental Health Llc | |
|
19377 Upland St Nw Elk River MN 55330-4140 | |
| (612) 237-7341 | |
| (612) 465-3032 |
| Full Name | Sequel Mental Health Llc |
|---|---|
| Speciality | Counselor |
| Location | 19377 Upland St Nw, Elk River, Minnesota |
| Authorized Official Name and Position | Jenny M Klutch (OWNER) |
| Authorized Official Contact | 6122377341 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sequel Mental Health Llc 19377 Upland St Nw Elk River MN 55330-4140 Ph: (612) 237-7341 | Sequel Mental Health Llc 19377 Upland St Nw Elk River MN 55330-4140 Ph: (612) 237-7341 |
| NPI Number | 1780321802 |
|---|---|
| Provider Enumeration Date | 05/19/2022 |
| Last Update Date | 05/19/2022 |
| Certification Date | 05/19/2022 |
| Medicare PECOS PAC ID | 7810436334 |
|---|---|
| Medicare Enrollment ID | O20240828004170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780321802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jennifer Marie Klutch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245520048 PECOS PAC ID: 9739462698 Enrollment ID: I20240828004545 |
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