Provider Demographics
NPI:1790224939
Name:VITALITY FAMILY MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:VITALITY FAMILY MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:612-200-0866
Mailing Address - Street 1:4149 LYNDALE AVE N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1703
Mailing Address - Country:US
Mailing Address - Phone:612-200-0866
Mailing Address - Fax:612-520-5662
Practice Address - Street 1:4149 LYNDALE AVE N
Practice Address - Street 2:SUITE 107
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1703
Practice Address - Country:US
Practice Address - Phone:612-200-0866
Practice Address - Fax:612-520-5662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302652101YA0400X, 103TA0400X
101YM0800X, 103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X, 103TP2701X, 106H00000X
MN244981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty