Provider Demographics
NPI:1720693146
Name:SERENE THERAPY AND COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:SERENE THERAPY AND COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HIBAQ
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUALEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-528-1065
Mailing Address - Street 1:777 BERRY ST APT 400B
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-4006
Mailing Address - Country:US
Mailing Address - Phone:651-528-1065
Mailing Address - Fax:
Practice Address - Street 1:777 BERRY ST APT 400B
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-4006
Practice Address - Country:US
Practice Address - Phone:651-528-1065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)