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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