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NPI Code Detail

MEDICARE: STEPS FOR CHANGE

MEDICARE: STEPS FOR CHANGE
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
1251S00000XCommunity/Behavioral Health AgencyCC01437MN

General Provider Information

NPI Number : 1255866984
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEPS FOR CHANGE
Provider Business Mailing Address
First Line : 6040 EARLE BROWN DR STE 302
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55430-9902
Country : US
Telephone Number : 612-860-8141
Fax Number :
Provider Business Practice Location Address
First Line : 2712 FREMONT AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-1122
Country : US
Telephone Number : 952-522-1814
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : JANAE SULLIVAN
Credential : LPCC
Telephone Number : 612-860-8141
Provider Enumeration Date : 05/01/2017
Last Update Date : 04/29/2024

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Directions to “STEPS FOR CHANGE ” Practice Location

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