MEDICARE: LIFE RENEWAL COUNSELING 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	1467	MN

General Provider Information

NPI Number	:	1497252530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE RENEWAL COUNSELING LLC

Provider Business Mailing Address
First Line	:	3000 COUNTY ROAD 42 W STE 303
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4827
Country	:	US
Telephone Number	:	952-500-9502
Fax Number	:	952-303-9502

Provider Business Practice Location Address
First Line	:	3000 COUNTY ROAD 42 W STE 303
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4827
Country	:	US
Telephone Number	:	952-500-9502
Fax Number	:	952-303-4692

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHEILA JEAN MARKER
Credential	:	MA, LMFT
Telephone Number	:	952-500-9502

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	05/29/2026

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