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NPI Code Detail

MEDICARE: BEYOND THE BRAIN THERAPIES INC.

MEDICARE: BEYOND THE BRAIN THERAPIES INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1114771656
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEYOND THE BRAIN THERAPIES INC.
Provider Business Mailing Address
First Line : 407 W BROADWAY AVE
Second Line :
City : FOREST LAKE
State : MN
Zip : 55025-1402
Country : US
Telephone Number : 651-307-4993
Fax Number :
Provider Business Practice Location Address
First Line : 407 W BROADWAY AVE
Second Line :
City : FOREST LAKE
State : MN
Zip : 55025-1402
Country : US
Telephone Number : 651-307-4993
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DEBRA ANN NELSON
Credential :
Telephone Number : 651-307-4993
Provider Enumeration Date : 04/12/2024
Last Update Date : 05/02/2024

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Directions to “BEYOND THE BRAIN THERAPIES INC. ” Practice Location

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