Organization
GOOD LIFE MENTAL HALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIMITRIY B ZELIKMAN LCSW (CLINICAL SOCIAL WORKER)
(612) 636-9268
Entity
Organization
Contact information
Practice address
13406 PINEVIEW CT, DAYTON, MN 55327-4500
(612) 636-9268
Mailing address
PO BOX 722793, SAN DIEGO, CA 92172-2793
(612) 636-9268
(612) 235-3392
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912367954
DIRECT PAY
CA
05
—
1982123105
—
MN
Enumeration date
09/09/2021
Last updated
09/09/2021
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