MEDICARE: CAMRI L NASETH LADC

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	106H00000X	Marriage & Family Therapist
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	304591	MN

General Provider Information

NPI Number	:	1407337470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMRI L NASETH LADC

Provider Business Mailing Address
First Line	:	1205 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2634
Country	:	US
Telephone Number	:	651-300-7942
Fax Number	:

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

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	03/11/2024

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