MEDICARE: MINNESOTA CARE COUNSELING 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
1	253Z00000X	In Home Supportive Care Agency	1075365-1-HCBS	MN
2	251S00000X	Community/Behavioral Health Agency	19934	MN

General Provider Information

NPI Number	:	1700265964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNESOTA CARE COUNSELING SERVICES, INC

Provider Business Mailing Address
First Line	:	3355 HIAWATHA AVE STE 112
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2443
Country	:	US
Telephone Number	:	612-644-9466
Fax Number	:	800-933-0968

Provider Business Practice Location Address
First Line	:	3355 HIAWATHA AVE STE 112
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2443
Country	:	US
Telephone Number	:	612-644-9466
Fax Number	:	800-933-0968

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	HUSSEIN MOHAMED
Credential	:	LGSW, MA
Telephone Number	:	612-644-9466

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	03/08/2017

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