Healthcare Provider Details

I. General information

NPI: 1992660211
Provider Name (Legal Business Name): STONEBRIDGE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 NORMANDALE LAKE BLVD STE 350
BLOOMINGTON MN
55437-3805
US

IV. Provider business mailing address

8500 NORMANDALE LAKE BLVD STE 350
BLOOMINGTON MN
55437-3805
US

V. Phone/Fax

Practice location:
  • Phone: 612-205-7792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARIAM FARAH
Title or Position: OWNER
Credential: DNP, PMHNP-BC
Phone: 612-205-7792