Healthcare Provider Details

I. General information

NPI: 1184921561
Provider Name (Legal Business Name): THE NEUROBEHAVIOR CENTER OF MINNESOTA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2011
Last Update Date: 09/04/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7913 RHODE ISLAND CIR
BLOOMINGTON MN
55438-1194
US

IV. Provider business mailing address

7913 RHODE ISLAND CIR
BLOOMINGTON MN
55438-1194
US

V. Phone/Fax

Practice location:
  • Phone: 952-956-2491
  • Fax:
Mailing address:
  • Phone: 952-956-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP5254
License Number StateMN

VIII. Authorized Official

Name: DANIEL C HOLLAND
Title or Position: OWNER/DIRECTOR
Credential: PHD., LICENSED PSYCH
Phone: 952-956-2491