Provider Demographics
NPI:1669180071
Name:ANEW HEALTH AND WELLNESS CLINIC
Entity type:Organization
Organization Name:ANEW HEALTH AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLESTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LADC
Authorized Official - Phone:651-402-4055
Mailing Address - Street 1:445 ETNA ST STE 55
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5848
Mailing Address - Country:US
Mailing Address - Phone:651-756-8561
Mailing Address - Fax:
Practice Address - Street 1:445 ETNA ST STE 55
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5848
Practice Address - Country:US
Practice Address - Phone:651-756-8561
Practice Address - Fax:651-493-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health