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5775 Wayzata Blvd Ste 255 Minneapolis MN 55416-1275 | |
| (952) 525-4500 | |
| (952) 525-1560 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 5775 Wayzata Blvd Ste 255, Minneapolis, Minnesota |
| Authorized Official Name and Position | William Sibert (CFO) |
| Authorized Official Contact | 6128840600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
720 Washington Ave Se Ste 200 Minneapolis MN 55414-2924 Ph: (612) 884-0600 | 5775 Wayzata Blvd Ste 255 Minneapolis MN 55416-1275 Ph: (952) 525-4500 |
| NPI Number | 1710592837 |
|---|---|
| Provider Enumeration Date | 09/15/2020 |
| Last Update Date | 12/04/2024 |
| Certification Date | 12/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710592837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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