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General NPI Number Information
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NPI Number | 1992061311
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Entity Type | Organization
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Legal Business Name | MERIDIAN BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 135 COLORADO ST E
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City | SAINT PAUL
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State | MN
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Zip | 55107-2244
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Country | US
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Telephone | 612-454-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 135 COLORADO ST E
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City | SAINT PAUL
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State | MN
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Zip | 55107-2244
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Country | US
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Telephone | 612-454-2345
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Fax |
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Authorized Official
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Title or Position | CHEMICAL DEPENDENCY COUNSELOR
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Name | MS. MELISSA CAROL HEITZINGER
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Credential | LADC
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Telephone | 612-454-2345
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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 | 303284
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License Number State | MN
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