Provider Demographics
NPI:1427192814
Name:ST. ANTHONY MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:ST. ANTHONY MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-634-4082
Mailing Address - Street 1:2233 HAMLINE AVE N
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5009
Mailing Address - Country:US
Mailing Address - Phone:651-634-4082
Mailing Address - Fax:
Practice Address - Street 1:2233 HAMLINE AVE N
Practice Address - Street 2:SUITE 402
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5009
Practice Address - Country:US
Practice Address - Phone:651-634-4082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty