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Organization

TUBMAN

Active
Other names
Tubman Family Alliance & Chrysalis A Center for Women Inc
Organization subpart
No

Provider details

NPI number
Authorized official
BEVERLY DUSSO (EXECUTIVE DIRECTOR)
(612) 767-6690
Entity
Organization

Contact information

Practice address
4432 CHICAGO AVENUE SOUTH, MINNEAPOLIS, MN 55407
(612) 870-2444
(612) 870-2428
Mailing address
4432 CHICAGO AVENUE SOUTH, MINNEAPOLIS, MN 55407
(612) 870-2444
(612) 870-2428

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
8004872MHC
MN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
257080700
MN
Enumeration date
08/31/2006
Last updated
11/04/2008
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