Organization
GAMBLER'S RELIEF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH RUSSO (BUSINESS OFFICE MANAGER)
(952) 224-2990
Entity
Organization
Contact information
Practice address
2960 JUDICIAL RD, 210, BURNSVILLE, MN 55337-5507
(952) 224-2990
(952) 224-2990
Mailing address
2960 JUDICIAL RD, 210, BURNSVILLE, MN 55337-5507
(952) 224-2990
(952) 224-2990
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
302633
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103T00000X
Psychologist
Primary
LP3228
MN
Other
Enumeration date
12/30/2011
Last updated
12/30/2011
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