A Way Out Recovery Inc
Organization Active NPI Addiction (Substance Use Disorder) Counselor · Shakopee, MN
NPI 1255978490 · NPPES record last updated Sep 20, 2021
Key facts
- NPI
- 1255978490
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- Legal business name
- A WAY OUT RECOVERY INC
- Practice address
- 1240 3Rd Ave E Ste 107
Shakopee, MN 55379-1749 - Phone
- (612) 916-8770
- NPI assigned
- Dec 6, 2019
- Organization subpart
- No
Authorized official
- Name
- Derrick Wade Haase
- Title
- President
- Phone
- (612) 916-8770
National Provider Directory
Locations
1240 3rd Ave E
Ste 107
Shakopee, MN 55379
Phone (612) 916-8770
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | Yes |
Addresses
Primary practice location
1240 3Rd Ave E Ste 107
Shakopee, MN 55379-1749
Mailing address
1240 3Rd Ave E Ste 107
Shakopee, MN 55379-1749
Other names
- A Way Out Recovery Inc
Other providers in Shakopee, MN
All providers in Shakopee, MN · Addiction (Substance Use Disorder) Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.