Organization
GRAY MATTER PARTNERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK THEODORE ORTH LICENSED PSYCHOLOGIS (CLINICAL DIRECTOR)
(612) 716-3925
Entity
Organization
Contact information
Practice address
16809 260TH AVE, MC GRATH, MN 56350-4538
(612) 716-3925
Mailing address
16809 260TH AVE, MC GRATH, MN 56350-4538
(612) 716-3925
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
LP4963
MN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
LP4963
MN
Other
Enumeration date
02/18/2012
Last updated
02/18/2012
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