| Portlight Mental Health | |
|
5413 Nicollet Ave # 152 Minneapolis MN 55419-1927 | |
| (612) 524-8243 | |
| Not Available |
| Full Name | Portlight Mental Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 5413 Nicollet Ave # 152, Minneapolis, Minnesota |
| Authorized Official Name and Position | Michael Daly (LICENSED THERAPIST) |
| Authorized Official Contact | 6125248243 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portlight Mental Health 5413 Nicollet Ave # 152 Minneapolis MN 55419-1927 Ph: (612) 524-8243 | Portlight Mental Health 5413 Nicollet Ave # 152 Minneapolis MN 55419-1927 Ph: (612) 524-8243 |
| NPI Number | 1841776960 |
|---|---|
| Provider Enumeration Date | 07/11/2018 |
| Last Update Date | 07/11/2018 |
| Medicare PECOS PAC ID | 2668901497 |
|---|---|
| Medicare Enrollment ID | O20250123003143 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841776960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Michael Daly |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1972020329 PECOS PAC ID: 4486183217 Enrollment ID: I20250123003282 |
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