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Organization
INSTITUTE FOR THERAPY & BEHAVIOR CHANGE, LTD.
Active
Organization
INSTITUTE FOR THERAPY & BEHAVIOR CHANGE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN CONLON LICSW (CO-OWNER)
(952) 922-1977
Entity
Organization
Contact information
Practice address
3919 W 44TH ST STE 200, EDINA, MN 55424-1032
(952) 922-1977
(952) 922-1980
Mailing address
3919 W 44TH ST STE 200, EDINA, MN 55424-1032
(952) 922-1977
(952) 922-1980
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07678IN
BLUE SHIELD GROUP NUMBER
MN
Enumeration date
04/24/2007
Last updated
08/22/2020
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