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General NPI Number Information
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NPI Number | 1659212140
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Entity Type | Organization
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Legal Business Name | ATARAXIA MENTAL HEALTH PLCC
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 1030 COUNTY ROAD E W STE 220
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City | SHOREVIEW
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State | MN
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Zip | 55126-8153
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Country | US
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Telephone | 651-289-7300
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Fax | 651-289-7301
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Provider Business Mailing Address
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Address Line | 1030 COUNTY ROAD E W STE 220
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City | SHOREVIEW
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State | MN
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Zip | 55126-8153
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Country | US
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Telephone | 651-289-7300
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Fax | 651-289-7300
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MICHAEL GOEDKEN
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Credential | APRN,CNP, PMHNP-BC
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Telephone | 651-353-0571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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