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General NPI Number Information
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NPI Number | 1578292306
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Entity Type | Organization
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Legal Business Name | LIFESPAN MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 305 CEDAR ST STE 102
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City | MONTICELLO
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State | MN
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Zip | 55362-8304
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Country | US
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Telephone | 763-200-1160
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Fax | 763-645-5458
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Provider Business Mailing Address
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Address Line | 305 CEDAR ST STE 102
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City | MONTICELLO
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State | MN
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Zip | 55362-8304
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Country | US
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Telephone | 763-200-1160
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Fax | 763-645-5458
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Authorized Official
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Title or Position | OWNER
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Name | VICTORIA SYBILLA HADLEY
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Credential | APRN, CNP, PMHNP-BC
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Telephone | 763-297-3633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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