Organization
RIVER CITY MENTAL HEALTH CLINIC, P.A.
Active
Organization
RIVER CITY MENTAL HEALTH CLINIC, P.A.
Active
Other names
River City Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK P HANSEN PHD (CEO)
(651) 312-4569
Entity
Organization
Contact information
Practice address
1360 ENERGY PARK DR, SUITE 340, SAINT PAUL, MN 55108-5276
(651) 646-8985
(651) 646-3959
Mailing address
1360 ENERGY PARK DR, SUITE 340, SAINT PAUL, MN 55108-5276
(651) 646-8985
(651) 646-3959
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155441700
—
MN
01
—
41G99RI
BCBS MN
MN
01
—
42G08RI
BCBS MN
MN
01
—
42G12RI
BCBS MN
MN
01
—
85234
HEALTH PARTNERS
MN
01
—
98534
PERFERRED ONE
MN
Enumeration date
12/27/2005
Last updated
10/08/2008
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