Healthcare Provider Details

I. General information

NPI: 1285192252
Provider Name (Legal Business Name): CHAMAERA MONE BEYENE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHAMAERA MONE SOWELL LICSW

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

IV. Provider business mailing address

PO BOX 43
MINNEAPOLIS MN
55440-0043
US

V. Phone/Fax

Practice location:
  • Phone: 866-603-0016
  • Fax:
Mailing address:
  • Phone: 612-262-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25761
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25761
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: