MEDICARE: HYBRID BEHAVIORAL HEALTH

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

General Provider Information

NPI Number	:	1477934438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYBRID BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	618 ADAMS ST NE # 1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2144
Country	:	US
Telephone Number	:	847-721-5639
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 ADAMS ST NE # 1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2144
Country	:	US
Telephone Number	:	847-721-5639
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	EVAN LIEBERMAN
Credential	:
Telephone Number	:	847-721-5639

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	09/26/2024

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Directions to “HYBRID BEHAVIORAL HEALTH ” Practice Location

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