MEDICARE: THE EREKU FAMILY COUNSELING CENTER

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1780366724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EREKU FAMILY COUNSELING CENTER

Provider Business Mailing Address
First Line	:	2100 EMERSON AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2512
Country	:	US
Telephone Number	:	612-293-7004
Fax Number	:	612-486-8554

Provider Business Practice Location Address
First Line	:	2100 EMERSON AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2512
Country	:	US
Telephone Number	:	612-293-7004
Fax Number	:	612-486-8554

Authorized Official
Title or Position	:	MARRIAGE & FAMILY THERAPIST
Name	:	MRS. OLUREMI OLUSEUN EREKU
Credential	:	LMFT
Telephone Number	:	612-703-2520

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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