=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093522153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAUI COUNSELLING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2024
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3232 31ST ST S
-----------------------------------------------------
City | MOORHEAD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56560-6023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-491-3819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3232 31ST ST S
-----------------------------------------------------
City | MOORHEAD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56560-6023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-491-3819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | FOZIA ABDULLAHI
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 701-491-3819
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------