| Good Life Mental Halth Services Llc | |
|
13406 Pineview Ct Dayton MN 55327-4500 | |
| (612) 636-9268 | |
| Not Available |
| Full Name | Good Life Mental Halth Services Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 13406 Pineview Ct, Dayton, Minnesota |
| Authorized Official Name and Position | Dimitriy B Zelikman (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 6126369268 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Good Life Mental Halth Services Llc Po Box 722793 San Diego CA 92172-2793 Ph: (612) 636-9268 | Good Life Mental Halth Services Llc 13406 Pineview Ct Dayton MN 55327-4500 Ph: (612) 636-9268 |
| NPI Number | 1104595586 |
|---|---|
| Provider Enumeration Date | 09/09/2021 |
| Last Update Date | 09/09/2021 |
| Certification Date | 09/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104595586 | NPI | - | NPPES |
| 1912367954 | Other | CA | DIRECT PAY |
| 1982123105 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |