Premiere Mental Health LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PREMIERE MENTAL HEALTH LLC

Practice address

360 Sherman St Ste 290
Saint Paul, MN 55102-2564

Phone

(763) 913-8125

NPI assigned

Nov 8, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Princess Kou Gehyigon-WallaceNPI 1275190027

Title

Owner

Phone

(763) 913-8125

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Princess Gehyigon-Wallace

  • Psychiatric/Mental Health Nurse Practitioner
  • Fridley, MN
  • NPI 1275190027
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1023832938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 SHERMAN ST STE 290",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022564",
            "telephone_number": "763-913-8125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 SHERMAN ST STE 290",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022564",
            "telephone_number": "763-913-8125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERE MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-08",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "GEHYIGON-WALLACE",
        "authorized_official_first_name": "PRINCESS",
        "authorized_official_middle_name": "KOU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-913-8125"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Dental
• Premier Handicap Services
• Premier Health of Roseville, LTD
• Premier Health of West Saint Paul LTD
• Premier Service LLC
• Monica Premsukh, PHARM.D.
• Claire Mackenzie Prendergast, REGISTERED DIETITIAN
• Anna Prenevost, PA
• Pia Prenevost
• Michelle Leigh Presley

• Clinic/Center in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.