Healthcare Provider Details

I. General information

NPI: 1356957823
Provider Name (Legal Business Name): TWINCITIES THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 EDINA INDUSTRIAL BLVD STE 104
EDINA MN
55439-2915
US

IV. Provider business mailing address

5275 EDINA INDUSTRIAL BLVD STE 104
EDINA MN
55439-2915
US

V. Phone/Fax

Practice location:
  • Phone: 952-297-7690
  • Fax: 612-886-2618
Mailing address:
  • Phone: 952-297-7690
  • Fax: 612-886-2618

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: FOWZAYA ABDI
Title or Position: OWNER
Credential:
Phone: 952-297-7690