Healthcare Provider Details

I. General information

NPI: 1063164531
Provider Name (Legal Business Name): MERAKI LEGACY COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N MINNESOTA ST STE 3
NEW ULM MN
56073-1746
US

IV. Provider business mailing address

PO BOX 212
NEW ULM MN
56073-0212
US

V. Phone/Fax

Practice location:
  • Phone: 507-276-8383
  • Fax:
Mailing address:
  • Phone: 507-328-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BONNIE ROSE BERANEK-FORTWENGLER
Title or Position: THERAPIST/OWNER
Credential: LICSW
Phone: 507-328-0690