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General NPI Number Information
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NPI Number | 1659662971
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH UNLIMINTED
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 6053 HUDSON RD STE 150
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City | WOODBURY
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State | MN
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Zip | 55125-1015
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Country | US
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Telephone | 952-451-1547
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Fax |
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Provider Business Mailing Address
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Address Line | 6053 HUDSON RD STE 150
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City | WOODBURY
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State | MN
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Zip | 55125-1015
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Country | US
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Telephone | 952-451-1547
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/CLINIC DIRECTOR
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Name | JAMISON WAYNE OTTUM
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Credential | MS
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Telephone | 952-451-1547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18010
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License Number State | MN
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