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General NPI Number Information
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NPI Number | 1366264012
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Entity Type | Organization
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Legal Business Name | MERGING RIVERS LLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 4905 31ST AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55417-1403
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Country | US
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Telephone | 952-900-2749
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Fax | 952-333-7493
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Provider Business Mailing Address
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Address Line | 4905 31ST AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55417-1403
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Country | US
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Telephone | 952-900-2749
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Fax | 952-333-7493
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER BLAKE SULLIVAN
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Credential | LCSW, LICSW, LIMHP
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Telephone | 952-900-2749
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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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