Provider Demographics
NPI:1063164531
Name:MERAKI LEGACY COUNSELING SERVICES
Entity type:Organization
Organization Name:MERAKI LEGACY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BERANEK-FORTWENGLER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-328-0690
Mailing Address - Street 1:15 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3056
Mailing Address - Country:US
Mailing Address - Phone:507-328-0690
Mailing Address - Fax:
Practice Address - Street 1:15 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-3056
Practice Address - Country:US
Practice Address - Phone:507-276-8383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty