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Organization

DIVERSE MENTAL HEALTH RESPONSE LLC

Active
Other names
Diverse Mental Health Response
Organization subpart
No

Provider details

NPI number
Authorized official
MR. XENG Y PHA LICSW (OWNER)
(651) 425-1614
Entity
Organization

Contact information

Practice address
1400 QUEEN AVE N, MINNEAPOLIS, MN 55411-2926
(651) 425-1614
Mailing address
9216 WHITE OAKS TRL, CHAMPLIN, MN 55316-2675

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2084P0800X
Psychiatry Physician
251B00000X
Case Management Agency
251S00000X
Community/Behavioral Health Agency
261Q00000X
Clinic/Center
3104A0625X
Assisted Living Facility (Mental Illness)
320800000X
Mental Illness Community Based Residential Treatment Facility

Other

Enumeration date
09/13/2023
Last updated
07/30/2024
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