Healthcare Provider Details

I. General information

NPI: 1104653161
Provider Name (Legal Business Name): HOZHO PSYCHIATRY & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 BLUE GENTIAN RD STE 200
EAGAN MN
55121-1567
US

IV. Provider business mailing address

860 BLUE GENTIAN RD STE 200
EAGAN MN
55121-1567
US

V. Phone/Fax

Practice location:
  • Phone: 612-619-0021
  • Fax:
Mailing address:
  • Phone: 612-217-1737
  • Fax: 612-457-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MELVINA DENEAL BISSONETTE
Title or Position: OWNER
Credential: MD
Phone: 612-217-1737