Healthcare Provider Details

I. General information

NPI: 1215873427
Provider Name (Legal Business Name): VITAMIND PSYCHOTHERAPY & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 WHITE BEAR AVE N STE 125
MAPLEWOOD MN
55109-3721
US

IV. Provider business mailing address

2688 RICE ST UNIT 2068
LITTLE CANADA MN
55113-2201
US

V. Phone/Fax

Practice location:
  • Phone: 651-504-4285
  • Fax:
Mailing address:
  • Phone: 651-504-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GAO CHEE VANG
Title or Position: LICENSED THERAPIST AND SUPERVISOR
Credential: MSW, LICSW
Phone: 651-504-4285