Provider Demographics
NPI:1578292306
Name:LIFESPAN MENTAL HEALTH, PLLC
Entity Type:Organization
Organization Name:LIFESPAN MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:SYBILLA
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP, PMHNP-BC
Authorized Official - Phone:763-297-3633
Mailing Address - Street 1:305 CEDAR ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8300
Mailing Address - Country:US
Mailing Address - Phone:763-200-1160
Mailing Address - Fax:763-645-5458
Practice Address - Street 1:305 CEDAR ST STE 103
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8300
Practice Address - Country:US
Practice Address - Phone:763-200-1160
Practice Address - Fax:763-645-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty