Provider Demographics
NPI:1285400606
Name:MENTALFITNESSCONNECTION LLC
Entity type:Organization
Organization Name:MENTALFITNESSCONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BACKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LADC, LPCC
Authorized Official - Phone:612-478-8040
Mailing Address - Street 1:1512 S TIMBER RDG
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4742
Mailing Address - Country:US
Mailing Address - Phone:612-478-8040
Mailing Address - Fax:
Practice Address - Street 1:1512 S TIMBER RDG
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4742
Practice Address - Country:US
Practice Address - Phone:612-478-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder