Provider Demographics
NPI:1407553159
Name:MENTAL HEALTH ADVOCATE LLC
Entity Type:Organization
Organization Name:MENTAL HEALTH ADVOCATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-843-1079
Mailing Address - Street 1:3825 BAKKEN BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-5056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3825 BAKKEN BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-5056
Practice Address - Country:US
Practice Address - Phone:614-843-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health