Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Lifespan of Minnesota, Inc

Organization Mental Health Clinic/Center (Including Community Mental Health Center) · NPI 1710097274

Lifespan of Minnesota, Inc is a Mental Health Clinic/Center (Including Community Mental Health Center) in Burnsville, Minnesota. Works from 2 locations. Licensed in Minnesota.

Licensed in
MN
In the registry since
2006
Specialties on file
2
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12425 River Ridge Blvd #200
Burnsville, MN 55337-4871
Phone: (952) 562-8500
Fax: (952) 562-8501
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 13000 63rd Ave N, Maple Grove, MN 55369-6081 — (763) 553-4003

Specialties & licences

Mental Health Clinic/Center (Including Community Mental Health Center) (primary) Taxonomy 261QM0801X · Licence 7076053 00 (MN)
Mental Health Clinic/Center (Including Community Mental Health Center) Taxonomy 261QM0801X · Licence 7876190 00 (MN)

Record details

NPI number1710097274
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Traci Hackmann — Ceo/Clinical Director · (952) 562-8500
NPI enumeratedAugust 30, 2006
Last updated in NPPESJuly 21, 2022
Mailing address12425 River Ridge Blvd, 200, Burnsville, MN 55337-4871

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