Provider Demographics
NPI:1104490184
Name:MENTORING PROFESSIONALS, LLC DBA OAK TREE SUPPORT SERVICES
Entity type:Organization
Organization Name:MENTORING PROFESSIONALS, LLC DBA OAK TREE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC/DM, 245D LICENSED
Authorized Official - Phone:651-491-4282
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55055-0218
Mailing Address - Country:US
Mailing Address - Phone:651-797-2438
Mailing Address - Fax:651-478-7144
Practice Address - Street 1:303 21ST ST STE 222
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MN
Practice Address - Zip Code:55055-1182
Practice Address - Country:US
Practice Address - Phone:651-797-2438
Practice Address - Fax:651-478-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care