=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003674326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY MENTAL HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2024
-----------------------------------------------------
Last Update Date | 03/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2136 FORD PKWY # 5609
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55116-2850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-273-9074
-----------------------------------------------------
Fax | 651-240-6036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6437 INSPIRE CIR S
-----------------------------------------------------
City | COTTAGE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55016-4692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-273-9074
-----------------------------------------------------
Fax | 651-240-6036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TENBIT ETAFA
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 651-273-9074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------