Healthcare Provider Details

I. General information

NPI: 1902758071
Provider Name (Legal Business Name): NEURO ALLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 PORTLAND AVE STE 170
BURNSVILLE MN
55337-6878
US

IV. Provider business mailing address

12400 PORTLAND AVE STE 170
BURNSVILLE MN
55337-6878
US

V. Phone/Fax

Practice location:
  • Phone: 952-855-7727
  • Fax:
Mailing address:
  • Phone: 952-855-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURIE LYNN KINCADE
Title or Position: CLINICAL PSYCHOLOGIST; OWNER
Credential: PHD, LP, NCSP
Phone: 952-855-7727