=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871391995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERKABA INTEGRATIVE PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2025
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1023 LINWOOD AVE APT 4
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55105-3282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-321-3864
-----------------------------------------------------
Fax | 657-877-6316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1023 LINWOOD AVE APT 4
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55105-3282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-366-0336
-----------------------------------------------------
Fax | 657-877-6316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC, AGNP-BC, PAT-C
-----------------------------------------------------
Name | DR. REBECCA ANNE LENZ
-----------------------------------------------------
Credential | APRN, DNP
-----------------------------------------------------
Telephone | 651-321-3864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------