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General NPI Number Information
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NPI Number | 1659717502
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Entity Type | Organization
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Legal Business Name | TWIN CITIES CENTER FOR PSYCHOLOGY & WELLNESS, LLC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 1350 ENERGY LN STE 215
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City | SAINT PAUL
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State | MN
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Zip | 55108-5501
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Country | US
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Telephone | 651-212-4877
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Fax | 651-212-4872
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Provider Business Mailing Address
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Address Line | 1350 ENERGY LN STE 110A
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City | SAINT PAUL
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State | MN
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Zip | 55108-5254
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Country | US
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Telephone | 651-212-4877
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Fax | 651-212-4872
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAINHIA KHANG
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Credential | PSYD
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Telephone | 651-212-4877
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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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