Provider Demographics
NPI:1932126794
Name:THE MENTAL HEALTH COLLECTIVE
Entity Type:Organization
Organization Name:THE MENTAL HEALTH COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:612-822-8227
Mailing Address - Street 1:3548 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4119
Mailing Address - Country:US
Mailing Address - Phone:612-822-8227
Mailing Address - Fax:612-825-4204
Practice Address - Street 1:3548 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4119
Practice Address - Country:US
Practice Address - Phone:612-822-8227
Practice Address - Fax:612-825-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03303Medicare ID - Type UnspecifiedGROUP #