Healthcare Provider Details

I. General information

NPI: 1114814605
Provider Name (Legal Business Name): BEHAVIORAL CARE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 129TH AVE NE
BLAINE MN
55449-6264
US

IV. Provider business mailing address

1712 129TH AVE NE
BLAINE MN
55449-6264
US

V. Phone/Fax

Practice location:
  • Phone: 612-384-6156
  • Fax:
Mailing address:
  • Phone: 612-384-6156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. ABDI ALI HUSSEIN
Title or Position: OWNER/MANAGER
Credential:
Phone: 612-384-6156