=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992567077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE HORN BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2024
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 860 BLUE GENTIAN RD STE 200
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55121-1567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-990-5029
-----------------------------------------------------
Fax | 612-895-1500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 860 BLUE GENTIAN RD STE 200
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55121-1567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-990-5029
-----------------------------------------------------
Fax | 612-895-1500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | MRS. FATUMA A GUHAD
-----------------------------------------------------
Credential | APRN, CNP, PMHNP-BC
-----------------------------------------------------
Telephone | 612-735-0524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------