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General NPI Number Information
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NPI Number | 1427586296
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Entity Type | Organization
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Legal Business Name | PROJECT FRESH START INC.
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 05/24/2017
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Provider Practice Location Address
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Address Line | 2854 COLUMBUS AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1324
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Country | US
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Telephone | 612-354-7904
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7367
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-0367
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Country | US
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Telephone | 651-399-3307
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. PAMELS ROBIN ZELLER
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Credential |
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Telephone | 651-399-3307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 23792
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4593
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License Number State | MN
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