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General NPI Number Information
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NPI Number | 1659067643
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Entity Type | Organization
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Legal Business Name | DIY INTERVENTION LLC
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 3634 WHITE BEAR AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55110-4471
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Country | US
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Telephone | 763-516-8068
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Fax |
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Provider Business Mailing Address
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Address Line | 3634 WHITE BEAR AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55110-4471
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Country | US
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Telephone | 763-516-8068
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS DEVELOPMENT
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Name | JOEL CYCENAS
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Credential | M.DIV.
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Telephone | 763-516-8068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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