Provider Demographics
NPI:1780321802
Name:SEQUEL MENTAL HEALTH LLC
Entity type:Organization
Organization Name:SEQUEL MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KLUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-237-7341
Mailing Address - Street 1:19377 UPLAND ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4140
Mailing Address - Country:US
Mailing Address - Phone:612-237-7341
Mailing Address - Fax:612-465-3032
Practice Address - Street 1:19377 UPLAND ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4140
Practice Address - Country:US
Practice Address - Phone:612-237-7341
Practice Address - Fax:612-465-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty