| Avalon - Prospect Park | |
|
2800 University Ave Se Ste 202 Minneapolis MN 55414-4205 | |
| (612) 326-7555 | |
| Not Available |
| Full Name | Avalon - Prospect Park |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 2800 University Ave Se Ste 202, Minneapolis, Minnesota |
| Authorized Official Name and Position | Valerie Bundy (CONTROLLER) |
| Authorized Official Contact | 6123267555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avalon - Prospect Park 550 Main St New Brighton MN 55112-3271 Ph: (612) 326-7555 | Avalon - Prospect Park 2800 University Ave Se Ste 202 Minneapolis MN 55414-4205 Ph: (612) 326-7555 |
| NPI Number | 1225242241 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225242241 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1016848 (Minnesota) | Primary |
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