| Shining Light Skill Building Llc | |
|
3055 Old Highway 8 Ste 106b St. Anthony MN 55418 | |
| (612) 978-0760 | |
| Not Available |
| Full Name | Shining Light Skill Building Llc |
|---|---|
| Speciality | Psychologist - Cognitive & Behavioral |
| Location | 3055 Old Highway 8 Ste 106b, St. Anthony, Minnesota |
| Authorized Official Name and Position | Ahmed Cali Adam (ACCOUNT MANAGER) |
| Authorized Official Contact | 6129780760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shining Light Skill Building Llc 3055 Old Highway 8 Ste 106b St. Anthony MN 55418 Ph: (612) 978-0760 | Shining Light Skill Building Llc 3055 Old Highway 8 Ste 106b St. Anthony MN 55418 Ph: (612) 978-0760 |
| NPI Number | 1295347854 |
|---|---|
| Provider Enumeration Date | 08/17/2020 |
| Last Update Date | 11/05/2020 |
| Certification Date | 11/05/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295347854 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Primary |
Provision Mental Health Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4001 Stinson Blvd, Suite 300, St. Anthony, MN 55421 Phone: 612-401-1786 |