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General NPI Number Information
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NPI Number | 1992126429
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Entity Type | Organization
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Legal Business Name | ASSET CLINIC
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 332 MINNESOTA ST SUITE W1260
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City | SAINT PAUL
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State | MN
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Zip | 55101-1314
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Country | US
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Telephone | 651-341-7688
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Fax | 866-307-8760
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Provider Business Mailing Address
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Address Line | 332 MINNESOTA ST SUITE W1260
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City | SAINT PAUL
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State | MN
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Zip | 55101-1314
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Country | US
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Telephone | 651-341-7688
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Fax | 866-307-8760
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK L WILLENBRING
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Credential | M.D.
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Telephone | 651-348-7611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 1861
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License Number State | MN
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