Provider Demographics
NPI:1124423074
Name:MENTAL HEALTH NINJAS
Entity type:Organization
Organization Name:MENTAL HEALTH NINJAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CHAMPINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-230-3300
Mailing Address - Street 1:1550 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55423-4638
Mailing Address - Country:US
Mailing Address - Phone:651-321-8487
Mailing Address - Fax:
Practice Address - Street 1:1550 E 78TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55423-4638
Practice Address - Country:US
Practice Address - Phone:651-321-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare