MEDICARE: MR. HOA CANH LE LPCC, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	303351	MN
2	101YM0800X	Mental Health Counselor	1364	MN

General Provider Information

NPI Number	:	1558881136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HOA CANH LE LPCC, LADC

Provider Business Mailing Address
First Line	:	3460 WASHINGTON DR STE 110
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-4301
Country	:	US
Telephone Number	:	651-688-0488
Fax Number	:	844-700-2814

Provider Business Practice Location Address
First Line	:	3460 WASHINGTON DR STE 110
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-4301
Country	:	US
Telephone Number	:	651-688-0488
Fax Number	:	844-700-2814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	05/05/2023

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