Healthcare Provider Details

I. General information

NPI: 1639104193
Provider Name (Legal Business Name): DBT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7362 UNIVERSITY AVE NE SUITE 101
FRIDLEY MN
55432-3142
US

IV. Provider business mailing address

7362 UNIVERSITY AVE NE SUITE 101
FRIDLEY MN
55432-3142
US

V. Phone/Fax

Practice location:
  • Phone: 763-503-3981
  • Fax: 763-503-3981
Mailing address:
  • Phone: 763-503-3981
  • Fax: 763-503-3981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANNE MARIE GRESHAM
Title or Position: MANAGING PARTNER
Credential: ARNP
Phone: 763-503-3981