Healthcare Provider Details

I. General information

NPI: 1982134904
Provider Name (Legal Business Name): CHAD GEYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 COUNTY RD. 10
BROOKLYN CENTER MN
55429
US

IV. Provider business mailing address

3300 COUNTY ROAD 10
BROOKLYN CENTER MN
55429-3072
US

V. Phone/Fax

Practice location:
  • Phone: 763-560-8331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3213
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: