Provider Demographics
NPI:1477516250
Name:MENTAL HEALTH PROFESSIONALS INC
Entity Type:Organization
Organization Name:MENTAL HEALTH PROFESSIONALS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LODERMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:LP LMFT
Authorized Official - Phone:507-446-8123
Mailing Address - Street 1:1880 AUSTIN ROAD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060
Mailing Address - Country:US
Mailing Address - Phone:507-446-8123
Mailing Address - Fax:507-446-0600
Practice Address - Street 1:1880 AUSTIN ROAD
Practice Address - Street 2:SUITE #2
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060
Practice Address - Country:US
Practice Address - Phone:507-446-8123
Practice Address - Fax:507-446-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03423Medicare ID - Type Unspecified