Healthcare Provider Details

I. General information

NPI: 1154750016
Provider Name (Legal Business Name): RAMSEY COUNTY MENTAL HEALTH CLINIC IDDT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 UNIVERSITY AVE W STE 200
SAINT PAUL MN
55104-3453
US

IV. Provider business mailing address

1919 UNIVERSITY AVE W STE 200
SAINT PAUL MN
55104-3435
US

V. Phone/Fax

Practice location:
  • Phone: 651-266-7999
  • Fax:
Mailing address:
  • Phone: 651-266-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1065750
License Number StateMN

VIII. Authorized Official

Name: JULIE DUNCAN
Title or Position: MANAGER
Credential:
Phone: 651-266-7999