Healthcare Provider Details

I. General information

NPI: 1386405546
Provider Name (Legal Business Name): ANCHOR WAVE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7831 E BUSH LAKE RD STE 200D
MINNEAPOLIS MN
55439-3164
US

IV. Provider business mailing address

5800 DALE AVE
EDINA MN
55436-2473
US

V. Phone/Fax

Practice location:
  • Phone: 612-662-7407
  • Fax: 612-500-4918
Mailing address:
  • Phone: 561-779-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLYN BERGER
Title or Position: OWNER, THERAPIST
Credential: LPCC, LMHC
Phone: 561-779-8179