Healthcare Provider Details

I. General information

NPI: 1750004552
Provider Name (Legal Business Name): GOLDEN KIDS BEHAVIORAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 STINSON BLVD NE STE 314
MINNEAPOLIS MN
55421-3424
US

IV. Provider business mailing address

4001 STINSON BLVD NE STE 314
MINNEAPOLIS MN
55421-3424
US

V. Phone/Fax

Practice location:
  • Phone: 651-367-9613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN ABI
Title or Position: OWNER
Credential:
Phone: 651-367-9613