Healthcare Provider Details

I. General information

NPI: 1265974844
Provider Name (Legal Business Name): VOOS BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 RLCE STREET SUITE 108
LITTLE CANADA MN
55113
US

IV. Provider business mailing address

2353 RLCE STREET SUITE 108
LITTLE CANADA MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 651-340-5216
  • Fax:
Mailing address:
  • Phone: 651-340-5216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCC00494
License Number StateMN

VIII. Authorized Official

Name: MR. XULIVONG MOUA
Title or Position: PSYCHOTHERAPIST
Credential: MA, LPCC
Phone: 651-340-5216