Provider Demographics
NPI:1558108811
Name:MUND, TROY JEFFERY (LADC)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:JEFFERY
Last Name:MUND
Suffix:
Gender:M
Credentials:LADC
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Mailing Address - Street 1:4401 VALLEY VIEW ROAD
Mailing Address - Street 2:#7
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424
Mailing Address - Country:US
Mailing Address - Phone:612-231-2291
Mailing Address - Fax:952-926-6791
Practice Address - Street 1:7701 YORK AVE S. CLUB RECOVERY LLC.
Practice Address - Street 2:SUITE 350
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-926-2526
Practice Address - Fax:952-926-6791
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
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Provider Licenses
StateLicense IDTaxonomies
MN305042101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)