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General NPI Number Information
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NPI Number | 1023900560
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Entity Type | Individual
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Provider Name | AMOS KOUKOU MSW, LGSW
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Gender | Male
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 13603 80TH CIR N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-8961
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Country | US
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Telephone | 763-274-3120
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Fax |
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Provider Business Mailing Address
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Address Line | 6301 QUINWOOD LN N APT 212
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City | MAPLE GROVE
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State | MN
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Zip | 55369-5707
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Country | US
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Telephone | 406-215-6855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 32253
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License Number State | MN
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