Organization
AMETHYST COUNSELING SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY JON JOHNSON LADC (PROGRAM COORIDANATOR)
(651) 633-4532
Entity
Organization
Contact information
Practice address
1405 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-9301
(651) 633-4532
(651) 633-9311
Mailing address
1405 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-9301
(651) 633-4532
(651) 633-9311
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
820357100
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101961
UCARE
MN
01
—
18676
HEALTHPARTNERS
MN
01
—
4269AM
BLUE CROSS
MN
05
—
820357100
—
MN
01
—
8443304
UBH
MN
01
—
8460134
UBH
MN
01
—
8460135
UBH
MN
01
—
97081
PREFERREDONE
MN
Enumeration date
02/06/2007
Last updated
04/28/2008
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