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General NPI Number Information
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NPI Number | 1073077459
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Entity Type | Organization
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Legal Business Name | TWIN CITIES THERAPY SERVICES
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 327 MARSCHALL RD STE 395
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City | SHAKOPEE
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State | MN
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Zip | 55379-1680
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Country | US
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Telephone | 612-806-1403
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Fax |
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Provider Business Mailing Address
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Address Line | 327 MARSCHALL RD STE 395
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City | SHAKOPEE
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State | MN
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Zip | 55379-1680
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Country | US
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Telephone | 612-806-1403
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMATER MAHAMOUD
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Credential |
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Telephone | 952-236-7411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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