Organization
DIVERSE MENTAL HEALTH RESPONSE LLC
Active
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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