Healthcare Provider Details

I. General information

NPI: 1649095191
Provider Name (Legal Business Name): HEALING HEARTS & MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13144 OWATONNA ST NE
BLAINE MN
55449-3916
US

IV. Provider business mailing address

13144 OWATONNA ST NE
BLAINE MN
55449-3916
US

V. Phone/Fax

Practice location:
  • Phone: 612-441-7864
  • Fax:
Mailing address:
  • Phone: 612-441-7864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOHSEN MOHAMED
Title or Position: MANAGER
Credential:
Phone: 612-441-7864