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General NPI Number Information
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NPI Number | 1932486057
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Entity Type | Organization
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Legal Business Name | ALLIANT BEHAVIORAL PEDIATRICS
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 201 W TRAVELERS TRL SUITE 212
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City | BURNSVILLE
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State | MN
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Zip | 55337-2550
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Country | US
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Telephone | 651-295-7440
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Fax | 612-437-4499
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Provider Business Mailing Address
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Address Line | 201 W TRAVELERS TRL SUITE 212
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City | BURNSVILLE
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State | MN
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Zip | 55337-2550
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Country | US
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Telephone | 651-295-7440
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Fax | 612-437-4499
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JAMI J HUGHES
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Credential | PSY.D, BCBA-
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Telephone | 651-295-7440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-12557
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5121
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License Number State | MN
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