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General NPI Number Information
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NPI Number | 1144194002
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Entity Type | Organization
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Legal Business Name | LIVING WATERS YOUTH
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 5701 SHINGLE CREEK PKWY
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City | MINNEAPOLIS
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State | MN
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Zip | 55430-2467
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Country | US
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Telephone | 612-703-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 3107 JAMES AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55411-1243
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Country | US
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Telephone | 612-703-3313
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TANNEKA HARRINGTON
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Credential |
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Telephone | 612-703-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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