Provider Demographics
NPI:1396246898
Name:FORENSIC MENTAL HEALTH SPECIALISTS
Entity type:Organization
Organization Name:FORENSIC MENTAL HEALTH SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DISCH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:763-333-8001
Mailing Address - Street 1:657 MAIN ST NW STE 5
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1584
Mailing Address - Country:US
Mailing Address - Phone:763-333-8001
Mailing Address - Fax:
Practice Address - Street 1:11090 183RD CIR NW STE C
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2884
Practice Address - Country:US
Practice Address - Phone:763-333-8001
Practice Address - Fax:763-333-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01306261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)