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General NPI Number Information
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NPI Number | 1851922819
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Entity Type | Organization
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Legal Business Name | VALLEY PAIN RELIEF AND WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 2428 E 117TH ST
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City | BURNSVILLE
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State | MN
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Zip | 55337-1269
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Country | US
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Telephone | 612-444-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 2428 E 117TH ST
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City | BURNSVILLE
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State | MN
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Zip | 55337-1269
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Country | US
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Telephone | 612-444-3000
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Fax |
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Authorized Official
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Title or Position | VP, CEO
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Name | ASHWIN VINOD GEORGE
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Credential |
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Telephone | 612-444-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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