Provider Demographics
NPI:1659717502
Name:TWIN CITIES CENTER FOR PSYCHOLOGY & WELLNESS, LLC
Entity Type:Organization
Organization Name:TWIN CITIES CENTER FOR PSYCHOLOGY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAINHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-212-4877
Mailing Address - Street 1:1350 ENERGY LN STE 110A
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5254
Mailing Address - Country:US
Mailing Address - Phone:651-212-4877
Mailing Address - Fax:651-212-4872
Practice Address - Street 1:1350 ENERGY LN STE 110A
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5254
Practice Address - Country:US
Practice Address - Phone:651-212-4877
Practice Address - Fax:651-212-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1821356098Medicaid
MN1821356098Medicaid