Provider Demographics
NPI:1528726775
Name:EXPANSE - A MINNESOTA MENTAL HEALTH KETAMINE & PSYCHEDELIC PSYCHOTHER
Entity type:Organization
Organization Name:EXPANSE - A MINNESOTA MENTAL HEALTH KETAMINE & PSYCHEDELIC PSYCHOTHER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:612-296-0317
Mailing Address - Street 1:2701 UNIVERSITY AVE SE STE 204
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3236
Mailing Address - Country:US
Mailing Address - Phone:763-205-4843
Mailing Address - Fax:612-416-2085
Practice Address - Street 1:2701 UNIVERSITY AVE SE STE 204
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3236
Practice Address - Country:US
Practice Address - Phone:763-205-4843
Practice Address - Fax:612-416-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)