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General NPI Number Information
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NPI Number | 1669180071
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Entity Type | Organization
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Legal Business Name | ANEW HEALTH AND WELLNESS CLINIC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 445 ETNA ST STE 55
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City | SAINT PAUL
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State | MN
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Zip | 55106-5848
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Country | US
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Telephone | 651-756-8561
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Fax | 651-493-7057
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Provider Business Mailing Address
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Address Line | 445 ETNA ST STE 55
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City | SAINT PAUL
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State | MN
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Zip | 55106-5848
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Country | US
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Telephone | 651-756-8561
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHAELENE COLESTOCK
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Credential | LPCC, LADC
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Telephone | 651-402-4055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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