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General NPI Number Information
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NPI Number | 1891684601
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Entity Type | Organization
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Legal Business Name | GUIDED MENTAL HEALTH
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2615 CROWN HILL CT
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4910
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Country | US
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Telephone | 619-341-3420
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 CROWN HILL CT
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4910
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Country | US
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Telephone | 619-341-3420
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. HEATHER BACON
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Credential |
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Telephone | 619-341-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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