Organization
RENEW YOUR MIND - COUNSELING CONSULTING AND SUPERVISION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY M BOOZELL (CREDENTIAL SPECIALIST)
(218) 232-0856
Entity
Organization
Contact information
Practice address
15561 RAILROAD ST STE 203A, HAYWARD, WI 54843-5703
(651) 347-1380
Mailing address
9705N VIOLET LN, HAYWARD, WI 54843-1179
(651) 380-2235
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
302869
MN
101YP2500X
Professional Counselor
Primary
CC01151
MN
Other
Enumeration date
03/09/2018
Last updated
05/16/2024
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