Organization
GUILD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIA DUBAK (MEDICAL BILLING MANAGER)
(651) 286-8613
Entity
Organization
Contact information
Practice address
122 WABASHA ST S STE 400, SAINT PAUL, MN 55107-3394
(651) 450-2220
(651) 450-2221
Mailing address
122 WABASHA ST S STE 400, SAINT PAUL, MN 55107-3394
(651) 450-2220
(651) 450-2221
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
311ZA0620X
Adult Care Home Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
07/08/2008
Last updated
10/20/2025
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