Salah Mohamed Abu

Individual provider Active NPI Behavior Technician · Minneapolis, MN

NPI 1033946751 · NPPES record last updated Sep 17, 2024

Key facts

NPI
1033946751
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
121 Hennepin Ave
Minneapolis, MN 55401-1802
Phone
(612) 354-2424
Fax
(612) 288-1805
NPI assigned
Sep 17, 2024
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Lakes Counseling Services LLC Current
since Sep 29, 2024
Accepting new patients

Locations

121 Hennepin Ave
Minneapolis, MN 55401
Phone (612) 354-2424

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

121 Hennepin Ave
Minneapolis, MN 55401-1802

Mailing address

121 Hennepin Ave
Minneapolis, MN 55401-1802
Phone (612) 354-2424

Other providers in Minneapolis, MN

All providers in Minneapolis, MN · Behavior Technician in Minnesota

Sources for this page

Verify at the official NPI Registry.