Healthcare Provider Details

I. General information

NPI: 1982915898
Provider Name (Legal Business Name): INNER FOKUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 1ST ST STE 503
DULUTH MN
55802-1634
US

IV. Provider business mailing address

301 W 1ST ST STE 503
DULUTH MN
55802-1634
US

V. Phone/Fax

Practice location:
  • Phone: 949-939-9808
  • Fax:
Mailing address:
  • Phone: 949-939-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLP5150
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLP5150
License Number StateMN

VIII. Authorized Official

Name: DR. PATRICK ALEKNAVICIUS
Title or Position: PARTNER
Credential: PSY.D., L.P.
Phone: 949-939-9808