Sadie Briana Broekemeier, LPCC
Individual provider Active NPI Mental Health Counselor · Mora, MN
NPI 1104283779 · NPPES record last updated Feb 27, 2018
Key facts
- NPI
- 1104283779
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 949 (MN)
- Practice address
- 2031 Rowland Rd
Mora, MN 55051-7119 - Phone
- (763) 242-1400
- NPI assigned
- Jan 27, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302855 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| 949 | MN | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 302855 | MN | |
| Mental Health Counselor | 101YM0800X | 949 | MN | Yes |
Addresses
Primary practice location
2031 Rowland Rd
Mora, MN 55051-7119
Mailing address
11940 Louisiana Cir
Champlin, MN 55316-2213
Phone (763) 242-1400
Other providers in Mora, MN
- Mary Kay Borgstrom
- Brenda Ann Bosaaen
- Randall A Bostrom
- Shelley Bragelman
- Lori Braiedy
- Joseph John Buckley
- Aimee Burk
- Tanya Lynn Carlson
- Roberta Lorraine Casaday
- Teresa M Clark
All providers in Mora, MN · Mental Health Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.