Provider Demographics
NPI:1871019794
Name:LERO GROUP
Entity type:Organization
Organization Name:LERO GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLUFUNMILOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKANLA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-245-4257
Mailing Address - Street 1:345 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2091
Mailing Address - Country:US
Mailing Address - Phone:612-245-4257
Mailing Address - Fax:
Practice Address - Street 1:345 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2091
Practice Address - Country:US
Practice Address - Phone:612-245-4257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health