Organization
MIDWAY FAMILY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DRISS MOUKRIM (PRESIDENT/CEO)
(612) 242-4132
Entity
Organization
Contact information
Practice address
14214 DAVENPORT PATH, ROSEMOUNT, MN 55068-4177
(612) 644-6723
Mailing address
14214 DAVENPORT PATH, ROSEMOUNT, MN 55068
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/16/2017
Last updated
06/16/2017
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