Healthcare Provider Details

I. General information

NPI: 1104307800
Provider Name (Legal Business Name): MIDWEST CENTER FOR TRAUMA & EMOTIONAL HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16204 HIGHWAY 7
MINNETONKA MN
55345-3405
US

IV. Provider business mailing address

16204 HIGHWAY 7
MINNETONKA MN
55345-3405
US

V. Phone/Fax

Practice location:
  • Phone: 952-232-7712
  • Fax: 952-934-3010
Mailing address:
  • Phone: 952-232-7712
  • Fax: 952-934-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: DR. DAWN ELIZABETH MCCLELLAND
Title or Position: PH.D. PSYCHOLOGIST, CLINICAL DIRECT
Credential: PH.D.
Phone: 952-232-7712