| Prime Autism Center Inc | |
|
322 W Lake St Ste 207 Minneapolis MN 55408-5202 | |
| (612) 900-2854 | |
| Not Available |
| Full Name | Prime Autism Center Inc |
|---|---|
| Speciality | Psychologist - Cognitive & Behavioral |
| Location | 322 W Lake St Ste 207, Minneapolis, Minnesota |
| Authorized Official Name and Position | Shafici D Ali (PRESIDENT) |
| Authorized Official Contact | 6129002854 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Autism Center Inc 322 W Lake St Ste 207 Minneapolis MN 55408-5202 Ph: (612) 900-2854 | Prime Autism Center Inc 322 W Lake St Ste 207 Minneapolis MN 55408-5202 Ph: (612) 900-2854 |
| NPI Number | 1396311577 |
|---|---|
| Provider Enumeration Date | 05/28/2021 |
| Last Update Date | 05/28/2021 |
| Certification Date | 05/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396311577 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Primary |
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