| Blue Iris Therapy, Pllc | |
|
6437 Lyndale Ave S Suite 101 Richfield MN 55423-1465 | |
| (612) 455-4040 | |
| (612) 455-4041 |
| Full Name | Blue Iris Therapy, Pllc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6437 Lyndale Ave S, Richfield, Minnesota |
| Authorized Official Name and Position | Grant D Chikazawa-nelson (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 6126559776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Iris Therapy, Pllc 6437 Lyndale Ave S Suite 101 Richfield MN 55423-1465 Ph: (612) 455-4040 | Blue Iris Therapy, Pllc 6437 Lyndale Ave S Suite 101 Richfield MN 55423-1465 Ph: (612) 455-4040 |
| NPI Number | 1649564188 |
|---|---|
| Provider Enumeration Date | 06/01/2011 |
| Last Update Date | 06/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649564188 | NPI | - | NPPES |
| 227349918 | Other | MN | MEDICA-UBH |
| 540521 | Other | MN | VALUE OPTIONS |
| 143645 | Other | MN | U-CARE |
| 529100300 | Medicaid | MN | |
| 550045 02 | Other | MN | BHP |
| 69B22CH | Other | MN | BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 943 (Minnesota) | Primary |
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