MEDICARE: CREATE SPACE MEDITATE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NPI1437786761	OTHER		CLINICAL THERAPISTMSWERIN
2	NPI1760771810	OTHER		MTM PHARMACISTMAMARO
3	LPCC888MS	OTHER	MN	CLINICAL THERAPISTMSWERIN

General Provider Information

NPI Number	:	1477277671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATE SPACE MEDITATE, LLC

Provider Business Mailing Address
First Line	:	265 LONG LAKE CT
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-4803
Country	:	US
Telephone Number	:	651-338-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 LONG LAKE CT
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-4803
Country	:	US
Telephone Number	:	651-338-9707
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER / THERAPIST
Name	:	MICHELLE SWERIN
Credential	:	LPCC
Telephone Number	:	651-338-9707

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	11/29/2023

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