Provider Demographics
NPI:1235855107
Name:MENTALLURGY, PLLC
Entity Type:Organization
Organization Name:MENTALLURGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NEVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:828-719-9349
Mailing Address - Street 1:817 OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-3518
Mailing Address - Country:US
Mailing Address - Phone:828-719-9349
Mailing Address - Fax:
Practice Address - Street 1:817 OTTAWA AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-3518
Practice Address - Country:US
Practice Address - Phone:828-719-9349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty