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General NPI Number Information
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NPI Number | 1568079374
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Entity Type | Organization
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Legal Business Name | MIDWAY COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 1410 9TH AVE S APT 306
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City | SAINT CLOUD
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State | MN
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Zip | 56301-5787
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Country | US
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Telephone | 612-481-9981
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Fax | 320-416-3060
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Provider Business Mailing Address
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Address Line | 1410 9TH AVE S APT 306
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City | SAINT CLOUD
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State | MN
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Zip | 56301-5787
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Country | US
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Telephone | 612-481-9981
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Fax | 320-416-3060
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Authorized Official
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Title or Position | PRESIDENT
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Name | AZAD QORANE
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Credential |
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Telephone | 612-481-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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