MEDICARE: TOGETHER ANXIETY AND OCD TREATMENT LTD

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1841964947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOGETHER ANXIETY AND OCD TREATMENT LTD

Provider Business Mailing Address
First Line	:	4748 CHICAGO AVE STE 3
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-4320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4748 CHICAGO AVE STE 3
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-4320
Country	:	US
Telephone Number	:	612-599-3407
Fax Number	:

Authorized Official
Title or Position	:	LICSW
Name	:	TRACY F LEWIS
Credential	:	MSW, LICSW
Telephone Number	:	612-599-3407

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/03/2021

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