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NPI Code Detail

MEDICARE: GAUTHAM KRISHNAN

MEDICARE: GAUTHAM KRISHNAN
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1952150567
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAUTHAM KRISHNAN
Provider Business Mailing Address
First Line : 6390 DOUGLAS DR N APT 204
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55429-1980
Country : US
Telephone Number : 612-900-9385
Fax Number :
Provider Business Practice Location Address
First Line : 7400 METRO BLVD STE 227
Second Line :
City : EDINA
State : MN
Zip : 55439-2470
Country : US
Telephone Number : 612-712-5244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2024
Last Update Date : 05/15/2024

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Directions to “ GAUTHAM KRISHNAN ” Practice Location

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