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280 Smith Ave N Ste 450 St Paul MN 55102-2424 | |
| (651) 241-5959 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 280 Smith Ave N, St Paul, Minnesota |
| Authorized Official Name and Position | Dominica Tallarico (COO) |
| Authorized Official Contact | 6122222222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 43 Mail Route 10585 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | 280 Smith Ave N Ste 450 St Paul MN 55102-2424 Ph: (651) 241-5959 |
| NPI Number | 1265474704 |
|---|---|
| Provider Enumeration Date | 06/11/2006 |
| Last Update Date | 01/16/2025 |
| Certification Date | 01/16/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265474704 | NPI | - | NPPES |
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