=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265312607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONTEMPORARY MENTAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2025
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15088 22ND AVE NE STE 3
-----------------------------------------------------
City | LITTLE FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56345-3634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-429-7535
-----------------------------------------------------
Fax | 320-238-7528
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32518 RIVER VISTA LN
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56303-9564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-429-7535
-----------------------------------------------------
Fax | 320-238-7528
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER/OWNER
-----------------------------------------------------
Name | JULI SUZANNE BLACK
-----------------------------------------------------
Credential | APRN, CNP, PMHNP-BC
-----------------------------------------------------
Telephone | 320-429-7535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------