MEDICARE: ALTERNATIVES IN HEALING, LLC

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	1460478	MN

General Provider Information

NPI Number	:	1477852317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTERNATIVES IN HEALING, LLC

Provider Business Mailing Address
First Line	:	720 E 33RD ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2067
Country	:	US
Telephone Number	:	612-414-7997
Fax Number	:	612-870-8944

Provider Business Practice Location Address
First Line	:	720 E 33RD ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2067
Country	:	US
Telephone Number	:	612-414-7997
Fax Number	:	612-870-8944

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	DR. SANDY RAE JUNG
Credential	:	PSY.D., LPCC
Telephone Number	:	612-414-7997

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/17/2011

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