Healthcare Provider Details

I. General information

NPI: 1275977316
Provider Name (Legal Business Name): CENTERPOINTE BEHAVIORAL HEALTH MINNEAPOLIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W SUITE 314N
SAINT PAUL MN
55114-1052
US

IV. Provider business mailing address

763 S NEW BALLAS RD SUITE 300
SAINT LOUIS MO
63141-8704
US

V. Phone/Fax

Practice location:
  • Phone: 888-524-9196
  • Fax:
Mailing address:
  • Phone: 314-393-3954
  • Fax: 636-447-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IRSHAD KHAN
Title or Position: BUSINESS DEVELOPMENT
Credential:
Phone: 314-393-3954