MEDICARE: CALLI COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor
3	103G00000X	Clinical Neuropsychologist
4	163WP0808X	Psychiatric/Mental Health Registered Nurse
5	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1407162183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALLI COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	11334 86TH AVE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-4528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11334 86TH AVE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-4528
Country	:	US
Telephone Number	:	612-600-0853
Fax Number	:

Authorized Official
Title or Position	:	TRESURER
Name	:	ELIZABETH A ANDERSON
Credential	:
Telephone Number	:	612-600-0853

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	05/19/2022

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