Provider Demographics
NPI:1063653038
Name:ADULT AND MENTAL HEALTH SERVICES, PA
Entity Type:Organization
Organization Name:ADULT AND MENTAL HEALTH SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESDIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP,PSYD
Authorized Official - Phone:952-465-7942
Mailing Address - Street 1:13657 DULUTH DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-9203
Mailing Address - Country:US
Mailing Address - Phone:952-465-7942
Mailing Address - Fax:
Practice Address - Street 1:7373 147TH ST W
Practice Address - Street 2:SUITE 108
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7690
Practice Address - Country:US
Practice Address - Phone:952-465-7942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN927367-2103TC0700X, 363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty