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General NPI Number Information
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NPI Number | 1972300986
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Entity Type | Organization
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Legal Business Name | LIFELINE MENTAL HEALTH
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 787 HAMPDEN AVE UNIT 346
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City | SAINT PAUL
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State | MN
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Zip | 55114-2308
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Country | US
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Telephone | 678-358-9199
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 NICOLLET AVE STE 206
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-2575
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Country | US
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Telephone | 612-245-3864
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MISS DAALO SHABEL
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Credential |
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Telephone | 678-358-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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