Healthcare Provider Details

I. General information

NPI: 1679463038
Provider Name (Legal Business Name): INNER HARMONY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 UNIVERSITY AVE W STE 100E
SAINT PAUL MN
55114-8717
US

IV. Provider business mailing address

2469 UNIVERSITY AVE W STE 100E
SAINT PAUL MN
55114-8717
US

V. Phone/Fax

Practice location:
  • Phone: 612-520-1742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MUNA FARAH
Title or Position: EXECUTIVE
Credential:
Phone: 612-520-1742