| Phoenix Adolescent Outpatient Treatment | |
|
2055 White Bear Ave N Maplewood MN 55109-3716 | |
| (651) 734-3268 | |
| (612) 378-4886 |
| Full Name | Phoenix Adolescent Outpatient Treatment |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2055 White Bear Ave N, Maplewood, Minnesota |
| Authorized Official Name and Position | Howard Louis Meier (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6512301895 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Adolescent Outpatient Treatment 1011 Interlachen Pkwy Woodbury MN 55125-8852 Ph: (651) 230-0849 | Phoenix Adolescent Outpatient Treatment 2055 White Bear Ave N Maplewood MN 55109-3716 Ph: (651) 734-3268 |
| NPI Number | 1588833271 |
|---|---|
| Provider Enumeration Date | 02/27/2008 |
| Last Update Date | 02/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588833271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1048347-1-CDT (Minnesota) | Primary |
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