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General NPI Number Information
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NPI Number | 1013724053
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Entity Type | Organization
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Legal Business Name | COMMUNITY BASED MENTAL HEALTH CONSULTING AND TRAINING
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 965 AVON ST N APT 3
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City | SAINT PAUL
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State | MN
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Zip | 55103-1356
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Country | US
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Telephone | 612-888-7809
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Fax |
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Provider Business Mailing Address
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Address Line | 965 AVON ST N APT 3
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City | SAINT PAUL
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State | MN
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Zip | 55103-1356
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Country | US
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Telephone | 612-888-7809
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | NEIL GRECO
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Credential | LICSW
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Telephone | 612-888-7809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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