1053833517 NPI number — BETTER MENTAL HEALTH, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053833517 NPI number — BETTER MENTAL HEALTH, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTER MENTAL HEALTH, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053833517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 178
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55371-0178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-868-1696
Provider Business Mailing Address Fax Number:
763-412-1700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55371-1611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-412-1700
Provider Business Practice Location Address Fax Number:
763-324-8181
Provider Enumeration Date:
07/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
KELSEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
763-412-1700

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  302306 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: CC01560 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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