Provider Demographics
NPI:1356196687
Name:SERENITY BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:SERENITY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHUKRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:651-505-9911
Mailing Address - Street 1:3470 WASHINGTON DR STE 206
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1354
Mailing Address - Country:US
Mailing Address - Phone:651-505-9911
Mailing Address - Fax:
Practice Address - Street 1:3470 WASHINGTON DR STE 206
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1354
Practice Address - Country:US
Practice Address - Phone:651-505-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)