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General NPI Number Information
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NPI Number | 1902526437
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Entity Type | Organization
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Legal Business Name | AMETRINE MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 194 PROGRESS WAY
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City | SPICER
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State | MN
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Zip | 56288-5000
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Country | US
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Telephone | 320-640-2891
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Fax |
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Provider Business Mailing Address
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Address Line | 14802 1ST AVE E
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City | ATWATER
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State | MN
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Zip | 56209-9407
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Country | US
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Telephone | 612-220-3441
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JANAYA JEAN MARIE EVENSON
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Credential | PMHNP
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Telephone | 612-220-3441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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