Provider Demographics
NPI:1336761261
Name:MISSION MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:MISSION MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TEHUT
Authorized Official - Middle Name:
Authorized Official - Last Name:TEFERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-214-4605
Mailing Address - Street 1:1973 SLOAN PL STE 50B
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2084
Mailing Address - Country:US
Mailing Address - Phone:651-214-4605
Mailing Address - Fax:
Practice Address - Street 1:1973 SLOAN PL STE 50B
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55117-2084
Practice Address - Country:US
Practice Address - Phone:651-214-4605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty