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11990 Portland Ave Burnsville MN 55337-1516 | |
| (612) 568-6050 | |
| (952) 479-7896 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 11990 Portland Ave, Burnsville, Minnesota |
| Authorized Official Name and Position | Ashlee Noel Secord (OWNER) |
| Authorized Official Contact | 6125686050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11990 Portland Ave Burnsville MN 55337-1516 Ph: () - | 11990 Portland Ave Burnsville MN 55337-1516 Ph: (612) 568-6050 |
| NPI Number | 1013551803 |
|---|---|
| Provider Enumeration Date | 11/05/2019 |
| Last Update Date | 06/29/2022 |
| Certification Date | 04/01/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013551803 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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