Healthcare Provider Details

I. General information

NPI: 1366209652
Provider Name (Legal Business Name): HOPE REINS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36097 COUNTY 5 BLVD
LAKE CITY MN
55041-3303
US

IV. Provider business mailing address

36097 COUNTY 5 BLVD
LAKE CITY MN
55041-3303
US

V. Phone/Fax

Practice location:
  • Phone: 651-217-8510
  • Fax:
Mailing address:
  • Phone: 651-217-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE R KNUDSEN
Title or Position: OWNER/CLINIC DIRECTOR
Credential: LPCC
Phone: 651-217-8510