Provider Demographics
NPI:1902526437
Name:AMETRINE MENTAL HEALTH PLLC
Entity Type:Organization
Organization Name:AMETRINE MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JANAYA
Authorized Official - Middle Name:JEAN MARIE
Authorized Official - Last Name:EVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:612-220-3441
Mailing Address - Street 1:14802 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:MN
Mailing Address - Zip Code:56209-9407
Mailing Address - Country:US
Mailing Address - Phone:612-220-3441
Mailing Address - Fax:
Practice Address - Street 1:194 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:SPICER
Practice Address - State:MN
Practice Address - Zip Code:56288-5000
Practice Address - Country:US
Practice Address - Phone:320-640-2891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty