MEDICARE: INNER ROADTRIP

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1417800350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER ROADTRIP

Provider Business Mailing Address
First Line	:	4051 SHERIDAN AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4051 SHERIDAN AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1256
Country	:	US
Telephone Number	:	612-460-1131
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ZOE C JOHNSON
Credential	:	LPCC
Telephone Number	:	808-640-9093

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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Directions to “INNER ROADTRIP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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