Organization
MENTAL HEALTH UNLIMINTED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMISON WAYNE OTTUM MS (PSYCHOTHERAPIST/CLINIC DIRECTOR)
(952) 451-1547
Entity
Organization
Contact information
Practice address
6053 HUDSON RD, STE 150, WOODBURY, MN 55125-1015
(952) 451-1547
Mailing address
6053 HUDSON RD, STE 150, WOODBURY, MN 55125-1015
(952) 451-1547
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
18010
MN
251B00000X
Case Management Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659506525
MN MEDICAL ASSISTANCE
MN
01
—
1740440015
PSYCHOTHERAPIST
MN
Enumeration date
04/20/2011
Last updated
04/26/2011
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