MEDICARE: CLEARVIEW GUIDANCE CENTER

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	251S00000X	Community/Behavioral Health Agency	21047	MN

General Provider Information

NPI Number	:	1366844078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARVIEW GUIDANCE CENTER

Provider Business Mailing Address
First Line	:	15541 FLYBOAT LN
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-6021
Country	:	US
Telephone Number	:	651-307-3987
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ANTHONY LN S STE 200
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-2490
Country	:	US
Telephone Number	:	651-307-3987
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	JIHAN A ALI
Credential	:	LICSW
Telephone Number	:	651-307-3987

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/24/2014

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Directions to “CLEARVIEW GUIDANCE CENTER ” Practice Location

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