Basic Information
| Provider Information | |||||||||
| NPI: | 1740321678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAMSEY COUNTY ADULT MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 UNIVERSITY AVE W | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1919 UNIVERSITY AVE W | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 02/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | CONDUCY | ||||||||
| AuthorizedOfficialFirstName: | ALYSSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6512667900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RAMSEY COUNTY MENTAL HEALTH | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 174855600 | 05 | MN | MEDICAID |