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2025 Nicollet Ave Ste 100 Minneapolis MN 55404-2538 | |
| (952) 228-1346 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2025 Nicollet Ave Ste 100, Minneapolis, Minnesota |
| Authorized Official Name and Position | Asha Farhan Hassan (PRESIDENT/OWNER) |
| Authorized Official Contact | 9522281346 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2025 Nicollet Ave Ste 100 Minneapolis MN 55404-2538 Ph: (952) 228-1346 | 2025 Nicollet Ave Ste 100 Minneapolis MN 55404-2538 Ph: (952) 228-1346 |
| NPI Number | 1104456169 |
|---|---|
| Provider Enumeration Date | 01/17/2020 |
| Last Update Date | 01/30/2023 |
| Certification Date | 01/30/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104456169 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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