Healthcare Provider Details

I. General information

NPI: 1083332167
Provider Name (Legal Business Name): MERCIFUL RECOVERY COUNSELING & COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6745 12TH AVE S
RICHFIELD MN
55423-2629
US

IV. Provider business mailing address

6745 12TH AVE S
RICHFIELD MN
55423-2629
US

V. Phone/Fax

Practice location:
  • Phone: 612-900-6661
  • Fax:
Mailing address:
  • Phone: 612-900-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA STEARNS BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential: LADC
Phone: 612-900-6368