Organization
BONNIE BRAE PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SCHAEFFER (OWNER)
(612) 618-6268
Entity
Organization
Contact information
Practice address
821 RAYMOND AVE STE 440, SAINT PAUL, MN 55114-1525
(612) 552-7023
Mailing address
821 RAYMOND AVE STE 440, SAINT PAUL, MN 55114-1525
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336422161
—
MN
Enumeration date
09/15/2020
Last updated
09/15/2020
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