Organization
BLUE BEHAVIORAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAYRUS ABDIRAHMAN DUALE (PRESIDENT)
(614) 805-1982
Entity
Organization
Contact information
Practice address
10800 LYNDALE AVE S STE 250, BLOOMINGTON, MN 55420-5690
(614) 805-1982
Mailing address
10800 LYNDALE AVE S STE 250, BLOOMINGTON, MN 55420-5690
(614) 805-1982
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
10/12/2020
Last updated
09/14/2022
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