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1713 Southcross Dr W Burnsville MN 55306-7012 | |
| (952) 212-0080 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1713 Southcross Dr W, Burnsville, Minnesota |
| Authorized Official Name and Position | Sarah Robinson-hudson (OWNER) |
| Authorized Official Contact | 9522120080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1713 Southcross Dr W Burnsville MN 55306-7012 Ph: (952) 212-0080 | 1713 Southcross Dr W Burnsville MN 55306-7012 Ph: (952) 212-0080 |
| NPI Number | 1174972558 |
|---|---|
| Provider Enumeration Date | 06/07/2016 |
| Last Update Date | 12/16/2020 |
| Certification Date | 12/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174972558 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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