Organization
BLUE IRIS THERAPY, PLLC
Active
Other names
Blue Iris Center for Therapeutic Services, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRANT D CHIKAZAWA-NELSON PHD (OWNER/PSYCHOTHERAPIST)
(612) 655-9776
Entity
Organization
Contact information
Practice address
6437 LYNDALE AVE S, SUITE 101, RICHFIELD, MN 55423-1465
(612) 455-4040
(612) 455-4041
Mailing address
6437 LYNDALE AVE S, SUITE 101, RICHFIELD, MN 55423-1465
(612) 455-4040
(612) 455-4041
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
943
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143645
U-CARE
MN
01
—
227349918
MEDICA-UBH
MN
05
—
529100300
—
MN
01
—
540521
VALUE OPTIONS
MN
01
—
550045 02
BHP
MN
01
—
69B22CH
BC/BS
MN
Enumeration date
06/01/2011
Last updated
06/01/2011
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