Organization
MANZANITA THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELANIE ALFORD LICSW (OWNER/THERAPIST)
(612) 246-6689
Entity
Organization
Contact information
Practice address
5208 BLOOMINGTON AVE S, MINNEAPOLIS, MN 55417
(612) 246-6689
(612) 822-2216
Mailing address
5208 BLOOMINGTON AVE S, MINNEAPOLIS, MN 55417
(612) 246-6689
(612) 822-2216
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700229291
MEDICAID MINNESOTA (MA)
MN
Enumeration date
01/29/2014
Last updated
01/29/2014
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