Healthcare Provider Details

I. General information

NPI: 1588186548
Provider Name (Legal Business Name): PLUM BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 FIRE MONUMENT RD
HINCKLEY MN
55037-8310
US

IV. Provider business mailing address

208 FIRE MONUMENT RD
HINCKLEY MN
55037-8310
US

V. Phone/Fax

Practice location:
  • Phone: 877-758-6328
  • Fax:
Mailing address:
  • Phone: 877-758-6328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE BUTLER
Title or Position: OWNER
Credential:
Phone: 877-758-6328