Basic Information
| Provider Information | |||||||||
| NPI: | 1538344890 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLINA - MENTAL HEALTH SERVICES - UNITED HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 SMITH AVE N | ||||||||
| Address2: | MAIL ROUTE # 60222 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512418565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 SMITH AVE N | ||||||||
| Address2: | MAIL ROUTE # 60222 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512418565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2008 | ||||||||
| LastUpdateDate: | 01/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOERING | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR - PSYCHIATRY | ||||||||
| AuthorizedOfficialTelephone: | 6512418565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 1770 LAMFT | MN | Y | Hospital Units | Psychiatric Unit |
No ID Information.