Provider Demographics
NPI:1003631730
Name:GOODPLACE MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:GOODPLACE MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TOCHUKWU
Authorized Official - Last Name:NWANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-217-0240
Mailing Address - Street 1:10343 41ST PL NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-3045
Mailing Address - Country:US
Mailing Address - Phone:952-217-0240
Mailing Address - Fax:
Practice Address - Street 1:600 TWELVE OAKS CENTER DR STE 207
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4535
Practice Address - Country:US
Practice Address - Phone:952-217-0240
Practice Address - Fax:612-230-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone