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Organization

BLOSSOM WHOLE FAMILY THERAPY & CHILD PSYCHOLOGY CENTER, PLLC

Active
Other names
Blossom Child Psychology & Behavioral Health Center, PLLC
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GRETCHEN LEWIS-SNYDER PHD, LP (CHIEF MANAGER/PSYCHOLOGIST)
(612) 719-5422
Entity
Organization

Contact information

Practice address
10505 WAYZATA BLVD STE 103, MINNETONKA, MN 55305-1507
(952) 545-3300
(952) 545-3300
Mailing address
10505 WAYZATA BLVD STE 103, MINNETONKA, MN 55305-1507
(952) 545-3300
(952) 545-3300

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
LP4976
MN
261QM0850X
Adult Mental Health Clinic/Center
LP4976
MN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
LP4976
MN

Other

Enumeration date
09/30/2009
Last updated
08/28/2023
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