Provider Demographics
NPI:1376721589
Name:MENTAL HEALTH RESOURCES
Entity Type:Organization
Organization Name:MENTAL HEALTH RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-659-2900
Mailing Address - Street 1:762 TRANSFER RD STE 21
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1489
Mailing Address - Country:US
Mailing Address - Phone:651-659-2900
Mailing Address - Fax:651-645-7307
Practice Address - Street 1:501 HIGHWAY 13 E STE 116
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2877
Practice Address - Country:US
Practice Address - Phone:651-681-9366
Practice Address - Fax:651-645-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
395253301251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN395253301Medicaid