| Be Somebody Inc | |
|
11550 Stillwater Blvd N Ste 102 Lake Elmo MN 55042-8613 | |
| (651) 777-3336 | |
| Not Available |
| Full Name | Be Somebody Inc |
|---|---|
| Speciality | Psychologist |
| Location | 11550 Stillwater Blvd N Ste 102, Lake Elmo, Minnesota |
| Authorized Official Name and Position | Melissa B Severance (OWNER) |
| Authorized Official Contact | 6517773336 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Be Somebody Inc 11550 Stillwater Blvd N Ste 102 Lake Elmo MN 55042-8613 Ph: (651) 777-3336 | Be Somebody Inc 11550 Stillwater Blvd N Ste 102 Lake Elmo MN 55042-8613 Ph: (651) 777-3336 |
| NPI Number | 1073679791 |
|---|---|
| Provider Enumeration Date | 12/28/2006 |
| Last Update Date | 09/25/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073679791 | NPI | - | NPPES |
| 41D04SE | Other | MN | BCBS GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP3637 (Minnesota) | Primary |
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