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Organization
CHILDRENS HEALTH CARE
Active
Organization
CHILDRENS HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA LU ALEXANDER MCCORMICK (SR. VP AND CHIEF FINANCIAL OFFICER)
(612) 813-6129
Entity
Organization
Contact information
Practice address
2525 CHICAGO AVE S, CHILDRENS SPECIALITY CLINIC PSYCHOLOGICAL SERVICES MPLS, MINNEAPOLIS, MN 55404
(612) 813-8455
(612) 813-8263
Mailing address
5901 LINCOLN DRIVE, CBC-2-REV/PE, EDINA, MN 55436-1611
(952) 992-5691
(952) 992-6917
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
331018
MN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
331018
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
435247500
—
MN
Enumeration date
09/08/2006
Last updated
10/31/2022
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