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NPI Code Detail

MEDICARE: FIRST CHOICE AUTISM SERVICES INC

MEDICARE: FIRST CHOICE AUTISM 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
1103TC2200XClinical Child & Adolescent Psychologist

General Provider Information

NPI Number : 1609564822
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIRST CHOICE AUTISM SERVICES INC
Provider Business Mailing Address
First Line : 1913 BROADWAY ST NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-2627
Country : US
Telephone Number : 952-657-9064
Fax Number :
Provider Business Practice Location Address
First Line : 1913 BROADWAY ST NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-2627
Country : US
Telephone Number : 952-657-9064
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KHADRA MOHAMUD
Credential :
Telephone Number : 952-657-9064
Provider Enumeration Date : 04/26/2023
Last Update Date : 05/10/2023

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Directions to “FIRST CHOICE AUTISM SERVICES INC ” Practice Location

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