MEDICARE: MJ COUNSELING, LLC

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	:	1952016768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJ COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1960 CLIFF LAKE RD STE 129-179
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-2476
Country	:	US
Telephone Number	:	651-505-5349
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 CLIFF LAKE RD STE 129-179
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-2476
Country	:	US
Telephone Number	:	651-505-5349
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARYJO MELANDER
Credential	:	MSW, LICSW
Telephone Number	:	651-335-5548

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	01/16/2023

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