Basic Information
| Provider Information | |||||||||
| NPI: | 1376948810 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENTAL HEALTH SYSTEMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 FRANCE AVE S | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554351805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528352002 | ||||||||
| FaxNumber: | 9528359889 | ||||||||
| Practice Location | |||||||||
| Address1: | 6600 FRANCE AVE S | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554351805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528352002 | ||||||||
| FaxNumber: | 9528359889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2014 | ||||||||
| LastUpdateDate: | 10/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | PACYGA | ||||||||
| AuthorizedOfficialFirstName: | ERIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9528352002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CC00849 | MN | Y | Agencies | Community/Behavioral Health |
No ID Information.