Organization
MYHEALTH FOR TEENS & YOUNG ADULTS
Active
Other names
West Suburban Teen Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN LICHTY (DIRECTOR OF ADMIN. & OPS.)
(952) 767-0928
Entity
Organization
Contact information
Practice address
15 EIGHTH AVE. S., HOPKINS, MN 55343-7667
(952) 474-3251
(952) 767-0815
Mailing address
15 EIGHTH AVE. S., HOPKINS, MN 55343-7667
(952) 474-3251
(952) 767-0815
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
438964600
MINNESOTA HEALTH CARE PROGRAM
MN
01
—
984772
UNITED HEALTHCARE
MN
01
—
OAF89WE
BLUECROSS BLUESHIELD
MN
Enumeration date
09/13/2010
Last updated
12/22/2016
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