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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