Provider Demographics
NPI:1497506299
Name:INTREPID MENTAL HEALTH
Entity Type:Organization
Organization Name:INTREPID MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:507-591-0055
Mailing Address - Street 1:1208 COUNTY ROAD 63
Mailing Address - Street 2:
Mailing Address - City:BALATON
Mailing Address - State:MN
Mailing Address - Zip Code:56115-3119
Mailing Address - Country:US
Mailing Address - Phone:651-402-8765
Mailing Address - Fax:
Practice Address - Street 1:1208 COUNTY ROAD 63
Practice Address - Street 2:
Practice Address - City:BALATON
Practice Address - State:MN
Practice Address - Zip Code:56115-3119
Practice Address - Country:US
Practice Address - Phone:501-591-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)