Organization
COMMUNITY INVOLVEMENT PROGRAMS
Active
Organization
COMMUNITY INVOLVEMENT PROGRAMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY I SULLIVAN CPRP MA (MENTAL HEALTH SERVICES DIRECTOR)
(612) 362-4449
Entity
Organization
Contact information
Practice address
1600 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2617
(612) 362-4444
(612) 362-4479
Mailing address
1600 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2617
(612) 362-4444
(612) 362-4479
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
176398
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
176398
USPRA
MN
Enumeration date
07/03/2008
Last updated
07/03/2008
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