Healthcare Provider Details

I. General information

NPI: 1477940229
Provider Name (Legal Business Name): BABYLOVE ALLIANCE LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 SCOTT TRL STE 102
EAGAN MN
55122-3331
US

IV. Provider business mailing address

4590 SCOTT TRL STE 102
EAGAN MN
55122-3331
US

V. Phone/Fax

Practice location:
  • Phone: 651-200-3343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL CLANCY
Title or Position: EXECUTIVE DIR OF CLINICAL PRACTICE
Credential: M.A. LMFT
Phone: 612-548-4266