Organization
PHOENIX MENTAL HEALTH, P.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SHEA JONES (PRESIDENT)
(612) 501-6807
Entity
Organization
Contact information
Practice address
1911 NICOLLET AVE # 210, MINNEAPOLIS, MN 55403-3747
(612) 501-6807
(866) 591-9475
Mailing address
1911 NICOLLET AVE # 210, MINNEAPOLIS, MN 55403-3747
(612) 501-6807
(866) 591-9475
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
18233
MN
261QC1500X
Community Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831329564
—
MN
Enumeration date
07/15/2009
Last updated
07/15/2022
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