| NPI | 1194059642 |
|---|---|
| Former Legal Business Name | BLOSSOM CHILD PSYCHOLOGY & BEHAVIORAL HEALTH CENTER, PLLC |
| Entity Type | Organization |
| Authorized Contact | GRETCHEN LEWIS-SNYDER Chief Manager/Psychologist 612-719-5422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MN LP4976) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN LP4976) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: MN LP4976) | |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2023-08-28 |