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1346356938

NPI Code Detail

MEDICARE: TAI J MENDENHALL LMFT, PHD

MEDICARE: TAI J MENDENHALL LMFT, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1318	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1042738	OTHER	MN	PREFERRED ONE
2	124040	OTHER	MN	UCARE
3	270K3ME	OTHER	MN	BCBS MN NUMBER
4	62-53752	OTHER	MN	UBH/MEDICA NUMBER
5	026	OTHER	MN	TRIWEST
6	HP42677	OTHER	MN	HEALTHPARTNERS

General Provider Information

NPI Number	:	1346356938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAI J MENDENHALL LMFT, PHD

Provider Business Mailing Address
First Line	:	1414 MARYLAND AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-2824
Country	:	US
Telephone Number	:	651-772-3461
Fax Number	:	651-772-2605

Provider Business Practice Location Address
First Line	:	1414 MARYLAND AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-2824
Country	:	US
Telephone Number	:	651-772-3461
Fax Number	:	651-772-2605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/09/2007

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Directions to “ TAI J MENDENHALL LMFT, PHD” Practice Location

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