=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902411093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BECOMING BEHAVIORAL HEALTH & WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2020
-----------------------------------------------------
Last Update Date | 12/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7900 INTERNATIONAL DR STE 300
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55425-2562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-441-9240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7900 INTERNATIONAL DR STE 300
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55425-2562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-441-9240
-----------------------------------------------------
Fax | 866-351-1969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DANA EASON
-----------------------------------------------------
Credential | APN, PMHNP-BC
-----------------------------------------------------
Telephone | 708-441-9240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------