Healthcare Provider Details

I. General information

NPI: 1700265964
Provider Name (Legal Business Name): MINNESOTA CARE COUNSELING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 HIAWATHA AVE STE 112
MINNEAPOLIS MN
55406-2443
US

IV. Provider business mailing address

3355 HIAWATHA AVE STE 112
MINNEAPOLIS MN
55406-2443
US

V. Phone/Fax

Practice location:
  • Phone: 612-644-9466
  • Fax: 800-933-0968
Mailing address:
  • Phone: 612-644-9466
  • Fax: 800-933-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number19934
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1075365-1-HCBS
License Number StateMN

VIII. Authorized Official

Name: HUSSEIN MOHAMED
Title or Position: PRESIDENT/CEO
Credential: LGSW, MA
Phone: 612-644-9466