Healthcare Provider Details

I. General information

NPI: 1497349138
Provider Name (Legal Business Name): TWIN CITIES COGNITIVE BEHAVIORAL TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 METRO BLVD STE 410
EDINA MN
55439-2326
US

IV. Provider business mailing address

7400 METRO BLVD STE 410
EDINA MN
55439-2326
US

V. Phone/Fax

Practice location:
  • Phone: 630-621-0661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARGARET MULLAGHY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 630-621-0661