Healthcare Provider Details

I. General information

NPI: 1720846215
Provider Name (Legal Business Name): MENDING MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 WENTWORTH AVE
RICHFIELD MN
55423-4133
US

IV. Provider business mailing address

7430 WENTWORTH AVE
RICHFIELD MN
55423-4133
US

V. Phone/Fax

Practice location:
  • Phone: 612-488-0040
  • Fax: 833-973-4055
Mailing address:
  • Phone: 612-488-0040
  • Fax: 833-973-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LEAH CLAUSEN
Title or Position: OWNER, DIRECTOR
Credential:
Phone: 612-488-0040