MEDICARE: PHOENIX MENTAL HEALTH, P.L.C.

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	261QC1500X	Community Health Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	251S00000X	Community/Behavioral Health Agency	18233	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831329564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX MENTAL HEALTH, P.L.C.

Provider Business Mailing Address
First Line	:	1911 NICOLLET AVE # 210
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3747
Country	:	US
Telephone Number	:	612-501-6807
Fax Number	:	866-591-9475

Provider Business Practice Location Address
First Line	:	1911 NICOLLET AVE # 210
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3747
Country	:	US
Telephone Number	:	612-501-6807
Fax Number	:	866-591-9475

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY SHEA JONES
Credential	:
Telephone Number	:	612-501-6807

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	07/15/2022

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Directions to “PHOENIX MENTAL HEALTH, P.L.C. ” Practice Location

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