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NPI Code Detail

MEDICARE: THE MENTAL HEALTH COLLECTIVE

MEDICARE: THE MENTAL HEALTH COLLECTIVE
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1932126794
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE MENTAL HEALTH COLLECTIVE
Provider Business Mailing Address
First Line : 3548 BRYANT AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-4119
Country : US
Telephone Number : 612-822-8227
Fax Number : 612-825-4204
Provider Business Practice Location Address
First Line : 3548 BRYANT AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-4119
Country : US
Telephone Number : 612-822-8227
Fax Number : 612-825-4204
Authorized Official
Title or Position : CO-DIRECTOR
Name : DR. LAURENCE ALAN KIVENS
Credential : PSY.D., L.P.
Telephone Number : 612-822-8227
Provider Enumeration Date : 07/17/2006
Last Update Date : 08/22/2020

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Practice Location Address:
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55408-4119
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Directions to “THE MENTAL HEALTH COLLECTIVE ” Practice Location

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