Healthcare Provider Details

I. General information

NPI: 1659717502
Provider Name (Legal Business Name): TWIN CITIES CENTER FOR PSYCHOLOGY & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 ENERGY LN STE 215
SAINT PAUL MN
55108-5501
US

IV. Provider business mailing address

1350 ENERGY LN STE 110A
SAINT PAUL MN
55108-5254
US

V. Phone/Fax

Practice location:
  • Phone: 651-212-4877
  • Fax: 651-212-4872
Mailing address:
  • Phone: 651-212-4877
  • Fax: 651-212-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. MAINHIA KHANG
Title or Position: OWNER
Credential: PSYD
Phone: 651-212-4877