Provider Demographics
NPI:1417040122
Name:MENTAL HEALTH ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP
Authorized Official - Phone:651-639-9660
Mailing Address - Street 1:2475 15TH ST NW STE F
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-5606
Mailing Address - Country:US
Mailing Address - Phone:651-639-9669
Mailing Address - Fax:651-633-9968
Practice Address - Street 1:2475 15TH ST NW STE F
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-5606
Practice Address - Country:US
Practice Address - Phone:651-639-9660
Practice Address - Fax:651-633-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty