Provider Demographics
NPI:1497835656
Name:MENTAL HEALTH SYSTEMS PC
Entity Type:Organization
Organization Name:MENTAL HEALTH SYSTEMS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LP
Authorized Official - Phone:952-835-2002
Mailing Address - Street 1:7200 FRANCE AVE
Mailing Address - Street 2:STE 327
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4310
Mailing Address - Country:US
Mailing Address - Phone:952-835-2002
Mailing Address - Fax:952-835-9889
Practice Address - Street 1:7200 FRANCE AVE
Practice Address - Street 2:STE 327
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4310
Practice Address - Country:US
Practice Address - Phone:952-835-2002
Practice Address - Fax:952-835-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN58068200Medicaid
8448303OtherMEDICA
103953OtherUCARE
1034301OtherPREFERRED ONE
92012OtherHEALTH PARTNERS
124R9MEOtherBCBS
124R9MEOtherBCBS