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Divine Legacy
Adolescent and Children Mental Health Clinic/Center in Brooklyn Center, Minnesota
NPI 1073072260

Divine Legacy is an Adolescent and Children Mental Health Clinic/Center based in Brooklyn Center, MN and is specialized in Adolescent and Children Mental Health. Divine Legacy practices in Brooklyn Center, MN. The NPI Number for Divine Legacy is 1073072260 and holds a License No. (Minnesota).

The current practice location address for Divine Legacy is 3300 County Road 10 Ste 318, Brooklyn Center, MN and can be reached out via phone at 763-439-2588.

Location: 3300 County Road 10 Ste 318, Brooklyn Center, MN, 55429-3066
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1073072260
Provider Name
Divine Legacy
Credential
Provider Entity Type
Organization
Address
3300 County Road 10 Ste 318, Brooklyn Center, MN, 55429-3066
Phone Number
763-439-2588
Fax Number
Provider Enumeration Date
03/18/2019
Last Update Date
03/13/2024
institution
Provider Business Practice Location Address Details
Address
3300 County Road 10 Ste 318
City
Brooklyn Center
State
Minnesota
Zip
55429-3066
Phone Number
763-439-2588
Fax Number
person
Provider Business Mailing Address Details
Address
3300 County Road 10 Ste 318
City
Brooklyn Center
State
Minnesota
Zip
55429-3066
Phone Number
763-439-2588
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Corporate Health
Taxonomy
261QC1800X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
261QM0801X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adult Mental Health
Taxonomy
261QM0850X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
person
Provider's Taxonomy Details 4
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adolescent and Children Mental Health
Taxonomy
261QM0855X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
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