Provider Demographics
NPI:1356059687
Name:MN MENTAL HEALTH SPECIALISTS PA
Entity type:Organization
Organization Name:MN MENTAL HEALTH SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARTINI-TISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPCC
Authorized Official - Phone:612-296-8901
Mailing Address - Street 1:6971 330TH LN NW
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-4930
Mailing Address - Country:US
Mailing Address - Phone:612-296-8901
Mailing Address - Fax:
Practice Address - Street 1:303 CREDIT UNION DR STE 12A
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-4010
Practice Address - Country:US
Practice Address - Phone:612-296-8901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1477706885Medicaid