Organization
INVICTUS PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL JAMES ANDERSON MSW LICSW (CLINICAL SOCIAL WORKER)
(612) 481-4049
Entity
Organization
Contact information
Practice address
11181 HILLSBORO AVE N, CHAMPLIN, MN 55316-3128
(612) 481-4049
Mailing address
11181 HILLSBORO AVE N, CHAMPLIN, MN 55316-3128
(612) 481-4049
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/17/2021
Last updated
06/17/2021
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