Maverick Mental Health LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MAVERICK MENTAL HEALTH LLC

Practice address

9900 13TH Ave N Ste 210
Plymouth, MN 55441-5068

Phone

(612) 310-2537

NPI assigned

Mar 20, 2024

Organization subpart

No

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

Authorized official

Name

Maktal Abdifatah Mohamed

Title

Owner

Phone

(612) 310-2537

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1710892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1093575581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 13TH AVE N STE 210",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554415068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 13TH AVE N STE 210",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554415068",
            "telephone_number": "612-310-2537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVERICK MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-20",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "MAKTAL",
        "authorized_official_middle_name": "ABDIFATAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-310-2537"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Faith Martins, CRNA
• Kelsey J. Mason, FNP-BC
• Miranda Massey, OTR/L
• Caroline Ruth Mathews, M.D.
• Beth W Matthews, LICSW
• Maxicare Minnesota, Inc
• Christopher Michael McAninch, M.D.
• Tanner James McArdle, MD
• Rachel Mae McCabe
• Ethan McCallum, PHD

• Clinic/Center in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 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.