MEDICARE: EL PRIMER PASO COUNSELING SERVICES, INC

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	1043440-2-CDT	MN

General Provider Information

NPI Number	:	1447548680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PRIMER PASO COUNSELING SERVICES, INC

Provider Business Mailing Address
First Line	:	3620 CENTRAL AVE NE
Second Line	:	SUITE 103
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-4844
Country	:	US
Telephone Number	:	612-788-4605
Fax Number	:	612-788-1902

Provider Business Practice Location Address
First Line	:	3620 CENTRAL AVE NE STE 103
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-1376
Country	:	US
Telephone Number	:	612-788-4605
Fax Number	:	612-788-1902

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. ROSALINO CRUZ VALENCIA
Credential	:	BA, LADC
Telephone Number	:	612-788-4605

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	07/20/2011

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