| Lion Youth & Community Services Llc | |
|
807 Division St S Northfield MN 55057-2430 | |
| (320) 420-1272 | |
| (320) 240-6814 |
| Full Name | Lion Youth & Community Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 807 Division St S, Northfield, Minnesota |
| Authorized Official Name and Position | Kenneth Longfellow Hanna (OWNER) |
| Authorized Official Contact | 3204201272 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lion Youth & Community Services Llc 600 25th Ave S Ste 209 Saint Cloud MN 56301-4866 Ph: (320) 420-1272 | Lion Youth & Community Services Llc 807 Division St S Northfield MN 55057-2430 Ph: (320) 420-1272 |
| NPI Number | 1902302722 |
|---|---|
| Provider Enumeration Date | 04/02/2018 |
| Last Update Date | 02/05/2025 |
| Certification Date | 02/05/2025 |
| Medicare PECOS PAC ID | 8224381645 |
|---|---|
| Medicare Enrollment ID | O20181031002108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902302722 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2571659 (Minnesota) | Primary |
| Provider Name | Kenneth Hanna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295812105 PECOS PAC ID: 2668725086 Enrollment ID: I20181031002281 |
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Centered Practice Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 401 Division St S, Suite C, Northfield, MN 55057 Phone: 507-649-7294 | |
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