Provider Demographics
NPI:1649638487
Name:SERENITY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:SERENITY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:715-497-6678
Mailing Address - Street 1:1599 SELBY AVE STE 105LL
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6375
Mailing Address - Country:US
Mailing Address - Phone:715-497-6678
Mailing Address - Fax:
Practice Address - Street 1:1599 SELBY AVE STE 105LL
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6375
Practice Address - Country:US
Practice Address - Phone:715-497-6678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18477251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health