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General NPI Number Information
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NPI Number | 1962757617
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Entity Type | Organization
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Legal Business Name | ARUBAH EMOTIONAL HEALTH SERVICES PA
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 3300 COUNTY ROAD 10 STE 204B
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-3072
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Country | US
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Telephone | 763-447-5573
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Fax | 763-273-8892
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Provider Business Mailing Address
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Address Line | 3300 COUNTY ROAD 10 STE 204B
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-3072
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Country | US
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Telephone | 763-447-5573
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Fax | 763-273-8892
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS ANISSA NICOLE KEYES
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Credential | MA, LMFT
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Telephone | 763-447-5573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2538
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2538
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License Number State | MN
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