Provider Demographics
NPI:1497464895
Name:MINER, MICHAEL (ADC-T)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MINER
Suffix:
Gender:M
Credentials:ADC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAYMOND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1700
Mailing Address - Country:US
Mailing Address - Phone:612-699-7764
Mailing Address - Fax:
Practice Address - Street 1:700 RAYMOND AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1700
Practice Address - Country:US
Practice Address - Phone:612-699-7764
Practice Address - Fax:833-590-2221
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2664101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)