Provider Demographics
NPI:1639343783
Name:MN MENTAL HEALTH CONSULTING LLC
Entity Type:Organization
Organization Name:MN MENTAL HEALTH CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-203-2961
Mailing Address - Street 1:7600 PARKLAWN AVE
Mailing Address - Street 2:#380
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5125
Mailing Address - Country:US
Mailing Address - Phone:612-203-2961
Mailing Address - Fax:952-831-0033
Practice Address - Street 1:7600 PARKLAWN AVE
Practice Address - Street 2:#380
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:612-203-2961
Practice Address - Fax:952-831-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-19
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1315251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health