MEDICARE: HOPE COUNSELING 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1316555188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE COUNSELING LLC

Provider Business Mailing Address
First Line	:	1903 GREELEY ST S STE 201
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-6279
Country	:	US
Telephone Number	:	651-430-1060
Fax Number	:	651-439-9299

Provider Business Practice Location Address
First Line	:	1903 GREELEY ST S STE 201
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-6279
Country	:	US
Telephone Number	:	651-430-1060
Fax Number	:	651-439-9299

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. FATAI ADESHINA POPOOLA
Credential	:	LGSW,LADC
Telephone Number	:	651-430-1060

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	07/17/2020

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