Healthcare Provider Details

I. General information

NPI: 1215480660
Provider Name (Legal Business Name): NORTH SHORE MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST SUITE 911
DULUTH MN
55802-1701
US

IV. Provider business mailing address

324 W SUPERIOR ST
DULUTH MN
55802-1701
US

V. Phone/Fax

Practice location:
  • Phone: 952-484-5140
  • Fax:
Mailing address:
  • Phone: 952-484-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC00848
License Number StateMN

VIII. Authorized Official

Name: ANGELA MARIE SEGNER I
Title or Position: LPCC, OWNER
Credential:
Phone: 218-270-5055