Healthcare Provider Details

I. General information

NPI: 1508651233
Provider Name (Legal Business Name): BRILLIANT MINDS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CARLSON PKWY STE 1050
MINNETONKA MN
55305-5219
US

IV. Provider business mailing address

601 CARLSON PKWY STE 1050
MINNETONKA MN
55305-5219
US

V. Phone/Fax

Practice location:
  • Phone: 888-888-8888
  • Fax:
Mailing address:
  • Phone: 888-888-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
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: KAMAL JAMA
Title or Position: DIRECTOR
Credential:
Phone: 888-888-8888