MEDICARE: KAIROS THERAPY INSTITUTE

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356006290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAIROS THERAPY INSTITUTE

Provider Business Mailing Address
First Line	:	3410 BOULDER TRL
Second Line	:
City	:	WEBSTER
State	:	MN
Zip	:	55088-3310
Country	:	US
Telephone Number	:	651-395-1791
Fax Number	:

Provider Business Practice Location Address
First Line	:	8609 LYNDALE AVE S STE 110
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-2733
Country	:	US
Telephone Number	:	612-688-5968
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RUTH GRAMBUSH
Credential	:	MA, LAMFT
Telephone Number	:	651-357-5164

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	11/04/2021

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Directions to “KAIROS THERAPY INSTITUTE ” Practice Location

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