Basic Information
| Provider Information | |||||||||
| NPI: | 1669986972 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOUCHSTONE MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2312 SNELLING AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554043157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127672162 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7590 LYRIC LN NE | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554323251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128746409 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2017 | ||||||||
| LastUpdateDate: | 11/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | HEROLD | ||||||||
| AuthorizedOfficialFirstName: | DARVIA | ||||||||
| AuthorizedOfficialMiddleName: | KIAH | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6127672162 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | 1087569 | MN | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.