MEDICARE: SERENITY 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1891434007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY COUNSELING SERVICES INC

Provider Business Mailing Address
First Line	:	4020 MINNEHAHA AVE STE 2075
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-4600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 MINNEHAHA AVE STE 2075
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-4600
Country	:	US
Telephone Number	:	612-702-0990
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SAHRA ALI
Credential	:
Telephone Number	:	612-702-0990

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	09/09/2024

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