MEDICARE: FORTINO RODRIGUEZ SANCHEZ LPCC

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	305506	MN
2	101YP2500X	Professional Counselor	03184	MN
3	101YM0800X	Mental Health Counselor	3184	MN
4	103T00000X	Psychologist	LP7278	MN

General Provider Information

NPI Number	:	1326884750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FORTINO RODRIGUEZ SANCHEZ LPCC

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	612-262-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 OSBORNE RD NE STE 210
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-2718
Country	:	US
Telephone Number	:	763-236-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2024
Last Update Date	:	01/05/2026

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