Diverse Mental Health Response LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

DIVERSE MENTAL HEALTH RESPONSE LLC

Practice address

1400 Queen Ave N
Minneapolis, MN 55411-2926

Phone

(651) 425-1614

NPI assigned

Sep 13, 2023

Last updated

Jul 30, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Xeng Y Pha, LICSWNPI 1518565126

Title

Owner

Phone

(651) 425-1614

Specialties & licenses 7

Addresses

Other names 1

• Diverse Mental Health Response Other name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Xeng Ying Pha

  • Clinical Social Worker
  • Minneapolis, MN
  • NPI 1518565126
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1477330330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9216 WHITE OAKS TRL",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553162675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 QUEEN AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112926",
            "telephone_number": "651-425-1614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSE MENTAL HEALTH RESPONSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-13",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "PHA",
        "authorized_official_first_name": "XENG",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-425-1614",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diverse Mental Health Response",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Diverse Mental Health Response",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kristin Marit Disori, M.D.
• Ruwan R Dissanayake, MD
• Joan Eve Distler
• Divergent Path Therapy PLLC
• Diverse Home Health Care
• Diversified Home Care Inc
• Diversity Union Group Home Limited Liability Company
• Carmen N Divertie, MD
• Divine Health and Counseling Services
• Alan Divine, M.D.

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.