Provider Demographics
NPI:1851053698
Name:SERENITY WELLNESS
Entity Type:Organization
Organization Name:SERENITY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHUKRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:651-497-6593
Mailing Address - Street 1:787 HAMPDEN AVE UNIT 423
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2309
Mailing Address - Country:US
Mailing Address - Phone:651-497-6593
Mailing Address - Fax:
Practice Address - Street 1:787 HAMPDEN AVE UNIT 423
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-2309
Practice Address - Country:US
Practice Address - Phone:651-497-6593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)