MEDICARE: UJIMA HEALING AND CONSULTING, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1487387056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UJIMA HEALING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	1404 14TH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3111
Country	:	US
Telephone Number	:	612-743-2155
Fax Number	:	612-466-6871

Provider Business Practice Location Address
First Line	:	1404 14TH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3111
Country	:	US
Telephone Number	:	161-274-3215
Fax Number	:	612-466-6871

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RASHIDA K FISHER
Credential	:	PHD, LPCC, LADC
Telephone Number	:	161-274-3215

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/01/2022

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