Healthcare Provider Details

I. General information

NPI: 1700621349
Provider Name (Legal Business Name): ABEBAYEHU GEBEYEHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 WHITE BEAR AVE N
SAINT PAUL MN
55106-1609
US

IV. Provider business mailing address

1118 HUBBARD AVE
SAINT PAUL MN
55104-1425
US

V. Phone/Fax

Practice location:
  • Phone: 651-278-7319
  • Fax:
Mailing address:
  • Phone: 651-276-5798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: