Provider Demographics
NPI:1386951317
Name:MYHEALTH FOR TEENS & YOUNG ADULTS
Entity type:Organization
Organization Name:MYHEALTH FOR TEENS & YOUNG ADULTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMIN. & OPS.
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-767-0928
Mailing Address - Street 1:15 EIGHTH AVE. S.
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7667
Mailing Address - Country:US
Mailing Address - Phone:952-474-3251
Mailing Address - Fax:952-767-0815
Practice Address - Street 1:15 EIGHTH AVE. S.
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7667
Practice Address - Country:US
Practice Address - Phone:952-474-3251
Practice Address - Fax:952-767-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN984772OtherUNITED HEALTHCARE
MN438964600OtherMINNESOTA HEALTH CARE PROGRAM
MNOAF89WEOtherBLUECROSS BLUESHIELD