Healthcare Provider Details

I. General information

NPI: 1891110177
Provider Name (Legal Business Name): OMNI MENTAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9298 CENTRAL AVE NE STE 310
BLAINE MN
55434-4219
US

IV. Provider business mailing address

9298 CENTRAL AVE NE STE 310
BLAINE MN
55434-4219
US

V. Phone/Fax

Practice location:
  • Phone: 651-955-4633
  • Fax: 651-440-9897
Mailing address:
  • Phone: 651-955-4633
  • Fax: 651-440-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2166
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LEE PINION
Title or Position: OWNER
Credential: MA, LMFT
Phone: 651-955-4633