Healthcare Provider Details

I. General information

NPI: 1427855519
Provider Name (Legal Business Name): ARBOL PSYCHIATRIC AND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 WAYZATA BLVD STE 875
ST LOUIS PARK MN
55416-1235
US

IV. Provider business mailing address

5775 WAYZATA BLVD STE 875
ST LOUIS PARK MN
55416-1235
US

V. Phone/Fax

Practice location:
  • Phone: 612-430-9790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/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: SHANNON MINNEHAN
Title or Position: OWNER
Credential: NP
Phone: 612-306-1888