Healthcare Provider Details

I. General information

NPI: 1780014399
Provider Name (Legal Business Name): MINNESOTA MULTI CULTURAL COUNSELLING AND CONSULTANT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6933 17TH AVE S
RICHFIELD MN
55423-2704
US

IV. Provider business mailing address

6933 17TH AVE S
RICHFIELD MN
55423-2704
US

V. Phone/Fax

Practice location:
  • Phone: 651-283-4745
  • Fax:
Mailing address:
  • Phone: 651-283-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberCC00670
License Number StateMN

VIII. Authorized Official

Name: MAGN O NYANG
Title or Position: CEO
Credential: PHD
Phone: 612-636-8926