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125 Se Main Street Suite 330 Minneapolis MN 55414 | |
| (952) 808-1400 | |
| (952) 808-1400 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 125 Se Main Street, Minneapolis, Minnesota |
| Authorized Official Name and Position | Kristin Aydt (LMFT/OWNER) |
| Authorized Official Contact | 9528081400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
760 Southcross Dr W Suite 103 Burnsville MN 55306 Ph: (952) 808-1400 | 125 Se Main Street Suite 330 Minneapolis MN 55414 Ph: (952) 808-1400 |
| NPI Number | 1760670087 |
|---|---|
| Provider Enumeration Date | 10/11/2007 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 1951573880 |
|---|---|
| Medicare Enrollment ID | O20111018000703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760670087 | NPI | - | NPPES |
| 742647000 | Other | MN | MA # |
| C05925 | Other | MEDICARE | |
| 1228 | Other | MN | LMFT LICENSE # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1228 (Minnesota) | Primary |
| Provider Name | Kristin Aydt |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1336248210 PECOS PAC ID: 4587836416 Enrollment ID: I20240307003596 |
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