MEDICARE: JIMMY QUACH

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	4027	MN

General Provider Information

NPI Number	:	1760106637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY QUACH

Provider Business Mailing Address
First Line	:	111 3RD AVE S STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2551
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 3RD AVE S STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2551
Country	:	US
Telephone Number	:	651-313-8080
Fax Number	:

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

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	01/01/2026

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Directions to “ JIMMY QUACH ” Practice Location

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