1467212969 NPI number — INNERCLARITY PSYCHIATRY & WELLNESS

Table of content: (NPI 1467212969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467212969 NPI number — INNERCLARITY PSYCHIATRY & WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNERCLARITY PSYCHIATRY & WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467212969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7738 206TH ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55044-4709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-468-5973
Provider Business Mailing Address Fax Number:
563-220-4832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 NORMANDALE LAKE BLVD STE 350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55437-3805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-222-7782
Provider Business Practice Location Address Fax Number:
563-220-4832
Provider Enumeration Date:
03/21/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KATTY
Authorized Official First Name:
AICHA
Authorized Official Middle Name:
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
952-222-7782

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)