Provider Demographics
NPI:1669918512
Name:LION COMMUNITY ENRICHMENT PROGRAMS, INC.
Entity type:Organization
Organization Name:LION COMMUNITY ENRICHMENT PROGRAMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LONGFELLOW
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:II
Authorized Official - Credentials:LICSW
Authorized Official - Phone:320-420-1272
Mailing Address - Street 1:600 25TH AVE S
Mailing Address - Street 2:SUITE #209
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4841
Mailing Address - Country:US
Mailing Address - Phone:320-420-1272
Mailing Address - Fax:320-240-6814
Practice Address - Street 1:600 25TH AVE S
Practice Address - Street 2:SUITE #209
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4841
Practice Address - Country:US
Practice Address - Phone:320-420-1272
Practice Address - Fax:320-240-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health