Great Lakes Arms Program

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

GREAT LAKES ARMS PROGRAM

Practice address

2917 15TH Ave S
Minneapolis, MN 55407-1427

Phone

(612) 414-7739

NPI assigned

Aug 12, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abdirahman Dhunkal, BOARD MEMBER

Title

Board Member

Phone

(612) 414-7739

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1508477514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2917 15TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071427",
            "telephone_number": "612-414-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2917 15TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071427",
            "telephone_number": "612-414-7739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ARMS PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "DHUNKAL",
        "authorized_official_first_name": "ABDIRAHMAN",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "612-414-7739",
        "authorized_official_credential": "BOARD MEMBER"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.