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General NPI Number Information
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NPI Number | 1629290762
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Entity Type | Organization
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Legal Business Name | NEW GUIDANCE COUNSELING CLINIC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8557 WYOMING AVE NORTH
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City | BROOKLYN CENTER
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State | MN
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Zip | 55445
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Country | US
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Telephone | 763-449-4404
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Fax | 763-494-5503
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Provider Business Mailing Address
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Address Line | 8557 WYOMING AVE NORTH
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City | BROOKLYN CENTER
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State | MN
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Zip | 55445
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Country | US
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Telephone | 763-449-4404
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Fax | 763-494-5503
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARY BURKETT
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Credential |
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Telephone | 763-494-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1017289-3-CDT
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License Number State | MN
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