Healthcare Provider Details

I. General information

NPI: 1043545189
Provider Name (Legal Business Name): THE COMMUNITY CIRCLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 NICOLLET CT SUITE 207
BURNSVILLE MN
55306-4501
US

IV. Provider business mailing address

14300 NICOLLET CT SUITE 207
BURNSVILLE MN
55306-4501
US

V. Phone/Fax

Practice location:
  • Phone: 952-898-7578
  • Fax: 952-898-7592
Mailing address:
  • Phone: 952-898-7578
  • Fax: 952-898-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number49576
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-03-1206
License Number StateFL

VIII. Authorized Official

Name: DR. RUTH M. MYERS
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 952-898-7578