Healthcare Provider Details

I. General information

NPI: 1639064165
Provider Name (Legal Business Name): MILESTONE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 COUNTY ROAD 10 STE 214
BROOKLYN CENTER MN
55429-3065
US

IV. Provider business mailing address

3300 COUNTY ROAD 10 STE 214
BROOKLYN CENTER MN
55429-3065
US

V. Phone/Fax

Practice location:
  • Phone: 612-306-3925
  • Fax:
Mailing address:
  • Phone: 612-306-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS ALEXANDER LAIGNEL
Title or Position: CO-FOUNDER/ADMINISTRATOR
Credential:
Phone: 612-306-3925