Organization
BLUE IRIS CENTER FOR THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRANT D CHIKAZAWANELSON PHD, LMFT (OWNER THERAPIST)
(612) 455-4040
Entity
Organization
Contact information
Practice address
6607 18TH AVE S, SUITE 201, RICHFIELD, MN 55423-2784
(612) 455-4040
(612) 455-4041
Mailing address
6607 18TH AVE S, SUITE 201, RICHFIELD, MN 55423-2784
(612) 455-4040
(612) 455-4041
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0943
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69B21CH
BLUE CROSS BLUE SHIELD
MN
Enumeration date
05/17/2007
Last updated
08/22/2020
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