Basic Information
| Provider Information | |||||||||
| NPI: | 1891275582 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENTAL HEALTH RESOURCES | ||||||||
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| OtherOrganizationName: | MHR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 762 TRANSFER RD STE 21 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551141489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516592914 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7766 HIGHWAY 65 NE | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637894895 | ||||||||
| FaxNumber: | 7637894798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOWELL | ||||||||
| AuthorizedOfficialFirstName: | CARLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOC DIR OF ACCTG & BUSINESS SERV | ||||||||
| AuthorizedOfficialTelephone: | 6513653612 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0802X | 30635 | MN | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
No ID Information.