MEDICARE: GENERATIONS COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	16475	MN

General Provider Information

NPI Number	:	1194041756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONS COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1620 RHODE ISLAND AVE N
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55427-4065
Country	:	US
Telephone Number	:	612-655-7678
Fax Number	:

Provider Business Practice Location Address
First Line	:	1595 SELBY AVE STE 203
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4528
Country	:	US
Telephone Number	:	612-655-7678
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DIONNE MARIE BLOOD
Credential	:	MSW, LICSW
Telephone Number	:	612-655-7678

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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