Organization
BEING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY RAICH (AUTHORIZED OFFICIAL)
(651) 456-8912
Entity
Organization
Contact information
Practice address
871 JEFFERSON AVE, SAINT PAUL, MN 55102-2506
(651) 456-8912
(855) 407-1613
Mailing address
871 JEFFERSON AVE, SAINT PAUL, MN 55102-2506
(514) 568-9126
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
18483
MN
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124384854
—
MN
Enumeration date
04/06/2012
Last updated
02/08/2022
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