Healthcare Provider Details

I. General information

NPI: 1487493979
Provider Name (Legal Business Name): MATTHEW CLIFFORD HELLING PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 1ST AVE NE STE 310
MINNEAPOLIS MN
55413-2419
US

IV. Provider business mailing address

234 MONTROSE PL APT 2
SAINT PAUL MN
55104-5631
US

V. Phone/Fax

Practice location:
  • Phone: 612-436-0295
  • Fax:
Mailing address:
  • Phone: 651-424-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10841
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: