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General NPI Number Information
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NPI Number | 1285443424
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Entity Type | Organization
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Legal Business Name | THRIVING MINDS LLC
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 2042 WOODDALE DR STE 250
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City | WOODBURY
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State | MN
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Zip | 55125-4421
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Country | US
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Telephone | 651-401-6030
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Fax |
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Provider Business Mailing Address
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Address Line | 6853 99TH ST S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-1071
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Country | US
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Telephone | 612-600-2856
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STELLA CHELLANGAT CHEMARUM
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Credential | PMHNP-BC
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Telephone | 612-600-2856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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