Provider Demographics
NPI:1992126429
Name:ASSET CLINIC
Entity type:Organization
Organization Name:ASSET CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLENBRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-348-7611
Mailing Address - Street 1:332 MINNESOTA ST
Mailing Address - Street 2:SUITE W1260
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1314
Mailing Address - Country:US
Mailing Address - Phone:651-341-7688
Mailing Address - Fax:866-307-8760
Practice Address - Street 1:332 MINNESOTA ST
Practice Address - Street 2:SUITE W1260
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1314
Practice Address - Country:US
Practice Address - Phone:651-341-7688
Practice Address - Fax:866-307-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1861261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health