Healthcare Provider Details

I. General information

NPI: 1548184872
Provider Name (Legal Business Name): INTEGRATED CARE NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DIVISION ST STE D
WAITE PARK MN
56387-1389
US

IV. Provider business mailing address

9570 JEFFERSON DR APT 4
CHANHASSEN MN
55317-2809
US

V. Phone/Fax

Practice location:
  • Phone: 320-200-9229
  • Fax:
Mailing address:
  • Phone: 320-200-9229
  • 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: NAIMA A HUSSEIN
Title or Position: OWNER
Credential: LPCC
Phone: 320-200-9229