Provider Demographics
NPI:1982103644
Name:VEEMAH INTEGRATED WELLNESS & CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:VEEMAH INTEGRATED WELLNESS & CONSULTING SERVICES, LLC
Other - Org Name:VEEMAH INTEGRATED WELLNESS & CONSULTING SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:KORPO
Authorized Official - Last Name:BALLAH-SWARAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:763-228-8086
Mailing Address - Street 1:11112 HILLSBORO AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11112 HILLSBORO AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3128
Practice Address - Country:US
Practice Address - Phone:763-228-8086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6152103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty