MEDICARE: RENAISSANCE CONSULTING MN 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1487319240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE CONSULTING MN LLC

Provider Business Mailing Address
First Line	:	19044 XAVIER ST NW
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-2871
Country	:	US
Telephone Number	:	763-202-9271
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 1ST AVE NE UNIT 1
Second Line	:
City	:	BUFFALO
State	:	MN
Zip	:	55313-1515
Country	:	US
Telephone Number	:	612-699-7990
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CHRISTINE JUNOD
Credential	:	LMFT
Telephone Number	:	612-699-7990

Provider Enumeration Date	:	11/05/2021
Last Update Date	:	06/27/2025

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