MEDICARE: CARMEN KIRCHHOFF

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588269229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN KIRCHHOFF

Provider Business Mailing Address
First Line	:	2012 BRYANT AVE S STE 5
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 BRYANT AVE S STE 5
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2819
Country	:	US
Telephone Number	:	612-405-0045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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