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NPI Code Detail

MEDICARE: BINOD PRASAD BASAULA MS, LADC, LPCC

MEDICARE: BINOD PRASAD BASAULA MS, LADC, LPCC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor305355MN
2101YM0800XMental Health Counselor3344MN

General Provider Information

NPI Number : 1629798897
Entity Type Code : Individual
Provider Name (Legal Business Name) : BINOD PRASAD BASAULA MS, LADC, LPCC
Provider Business Mailing Address
First Line : 9257 LOWER 6TH ST N
Second Line :
City : LAKE ELMO
State : MN
Zip : 55042-4101
Country : US
Telephone Number : 612-308-5068
Fax Number :
Provider Business Practice Location Address
First Line : 2000 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-3713
Country : US
Telephone Number : 651-437-4209
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2022
Last Update Date : 08/02/2024

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Directions to “ BINOD PRASAD BASAULA MS, LADC, LPCC” Practice Location

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