Provider Demographics
NPI:1629789821
Name:MERRANA LLC
Entity Type:Organization
Organization Name:MERRANA LLC
Other - Org Name:MINDBALANCE MENTAL HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ZEDGINIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:651-271-2956
Mailing Address - Street 1:4450 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4450 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5035
Practice Address - Country:US
Practice Address - Phone:612-441-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty