OrganizationActive
Lifespan of Minnesota, Inc.
NPI 1710097274 · Mental Health Clinic/Center (Including Community Mental Health Center) · Burnsville, MN
Provider details
- NPI number
- 1710097274
- Entity type
- Organization
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Traci Hackmann, Ceo/Clinical Director(952) 562-8500
- License
- 7876190 00 (MN)
Specialties & taxonomies
- Mental Health Clinic/Center (Including Community Mental Health Center)Primary261QM0801XLicense 7076053 00 (MN)
Ambulatory Health Care Facilities
- Mental Health Clinic/Center (Including Community Mental Health Center)261QM0801XLicense 7876190 00 (MN)
Ambulatory Health Care Facilities
Profile Score
Detailed profile(95/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
12425 River Ridge Blvd
#200
Burnsville, MN 55337-4871
Phone: (952) 562-8500
Fax: (952) 562-8501
Street-level locationGet directions
Mailing address
12425 River Ridge Blvd
Burnsville, MN 55337-4871
Additional practice locations (1)
- 13000 63rd Ave NMaple Grove, MN 55369-6081Phone: (763) 553-4003Fax: (763) 553-7743
Registry dates
- Enumerated
- 2006-08-30
- Last updated
- 2022-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.