| Philip Burton, | |
|
4470 W 78th Street Cir Ste 267, Bloomington, MN 55435-5408 | |
| (612) 424-5536 | |
| Not Available |
| Full Name | Philip Burton |
|---|---|
| Gender | Male |
| Speciality | Counselor - Professional |
| Location | 4470 W 78th Street Cir Ste 267, Bloomington, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174182984 | NPI | - | NPPES |
| 301962 | Other | MN | LADC LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Entity Name | Psych Recovery Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1316189541 PECOS PAC ID: 3779633912 Enrollment ID: O20090610000426 |
| Mailing Address | Practice Location Address |
|---|---|
| Philip Burton, 8131 34th Ave S Apt 425, Bloomington, MN 55425-1699 Ph: (612) 424-5536 | Philip Burton, 4470 W 78th Street Cir Ste 267, Bloomington, MN 55435-5408 Ph: (612) 424-5536 |
Abdulhakim D Mohamed, Counselor Medicare: Not Enrolled in Medicare Practice Location: 8200 Humboldt Ave S, Bloomington, MN 55431 Phone: 952-454-0421 Fax: 952-426-4935 | |
Ashley Ripley, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1801 American Blvd E Ste 8, Bloomington, MN 55425 Phone: 952-767-2267 | |
Zaynab Abdirahman Abdullahi, Counselor Medicare: Not Enrolled in Medicare Practice Location: 9340 James Ave S, Bloomington, MN 55431 Phone: 612-226-0907 | |
Ido Ahmed Weli, Counselor Medicare: Not Enrolled in Medicare Practice Location: 9340 James Ave S, Bloomington, MN 55431 Phone: 612-226-0907 | |
Adna Mohamud, Counselor Medicare: Not Enrolled in Medicare Practice Location: 9340 James Ave S, Bloomington, MN 55431 Phone: 612-226-0907 | |
Hussein Abdirahman Abdullahi, Counselor Medicare: Not Enrolled in Medicare Practice Location: 9340 James Ave S, Bloomington, MN 55431 Phone: 612-226-0907 | |
Naseeb Mohammed Ismaiel, Counselor Medicare: Not Enrolled in Medicare Practice Location: 9340 James Ave S, Bloomington, MN 55431 Phone: 612-226-0907 |