Good Life Mental Halth Services LLC
Organization Active NPI Adult Mental Health Clinic/Center · Dayton, MN
NPI 1104595586 · NPPES record last updated Sep 9, 2021
Key facts
- NPI
- 1104595586
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Mental Health Clinic/Center 261QM0850X
- Legal business name
- GOOD LIFE MENTAL HALTH SERVICES LLC
- Practice address
- 13406 Pineview CT
Dayton, MN 55327-4500 - Phone
- (612) 636-9268
- NPI assigned
- Sep 9, 2021
- Organization subpart
- No
Authorized official
- Name
- Dimitriy B Zelikman, LCSW
- Title
- Clinical Social Worker
- Phone
- (612) 636-9268
Practitioners 1
-
Dimitriy B Zelikman, LICSW
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Mental Health Clinic/Center | 261QM0850X | Yes |
Addresses
Primary practice location
13406 Pineview CT
Dayton, MN 55327-4500
Mailing address
PO Box 722793
San Diego, CA 92172-2793
Phone (612) 636-9268
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912367954 | Other | CA | DIRECT PAY |
| 1982123105 | Medicaid | MN |
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All providers in Dayton, MN · Adult Mental Health Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.