MINNESOTA TRAUMA RECOVERY INSTITUTE (NPI# 1598303794) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598303794 |
| Entity Type | Organization |
| Organization Name | MINNESOTA TRAUMA RECOVERY INSTITUTE |
| Practice Address |
1025 Portland Ave Minneapolis MN 55404-1449 |
| Mailing Address |
822 S 3rd St Ste 100 Minneapolis MN 55415-1200 |
| Practice Telephone | 6122174002 |
| Mailing Telephone | 6122174002 |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2019-12-18 |
| Authorized Official Name | MOLLY BAILEY (OWNER) |
| Authorized Official Telephone | 6122174002 |
| Authorized Official Credential | LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| Street Address |
1025 PORTLAND AVE |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55404-1449 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063590214 | Rs Eden Inc | Substance Abuse Rehabilitation Facility | 1025 Portland Ave, Minneapolis, MN 55404-1449 | 2006-11-02 |
| 1285272302 | Molly Bailey | Marriage & Family Therapist | 1025 Portland Ave, Minneapolis, MN 55404-1449 | 2019-12-19 |
| 1972993939 | The Couples Therapy Clinic, LLC | Marriage & Family Therapist | 1025 Portland Ave, Room 301, Minneapolis, MN 55404-1449 | 2015-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568062461 | Andrew Moe | Counselor | 2118 Blaisdell Ave S., Minneapolis, MN 55404 | 2020-10-29 |
| 1194368191 | Luz Angelica Fehn Salinas | Psychologist | 1315 E24th St, Minneapolis, MN 55404 | 2019-10-22 |
| 1760969125 | Bethany Karen Kenny | Registered Nurse | 910 E 26th St Ste 200, Minneapolis, MN 55404 | 2018-07-27 |
| 1225535701 | Karissa Dougherty | Nurse Practitioner | 2200 E Franklin Ave # 199, Minneapolis, MN 55404 | 2018-04-10 |
| 1891299491 | Guidance Home Health Care LLC | Home Health | 2529 Nicollet Avenue 202b, Minneapolis, MN 55404 | 2018-03-20 |
| 1770085490 | Bright Future Counseling Service, LLC | Counselor | 912 E. 24th St., Suite B215, Minneapolis, MN 55404 | 2018-03-08 |
| 1346754298 | Juba Pharmacy Inc | Pharmacy | 1926 Chicago Ave S, Minneapolis, MN 55404 | 2017-11-29 |
| 1629597323 | Kira Larson Fieldstrom | Social Worker | 2400 Blaisdell Ave., Minneapolis, MN 55404 | 2017-09-13 |
| 1770008930 | Nicole Lynn Sparks | Social Worker | 2445 Park Avenue, Minneapolis, MN 55404 | 2017-08-09 |
| 1639612765 | Cosmo Home Healthcare Services, L.L.C. | Home Health | 2219 Oakland Ave S, Suite 104, Minneapolis, MN 55404 | 2016-11-21 |
| Find all providers in zip 55404 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588278444 | Sam Chafos Trewick | Counselor | 3237 Fremont Ave S, Minneapolis, MN 55408-3531 | 2020-09-08 |
| 1962026781 | Dylan Thaemert | Counselor | 2012 Bryant Ave S Ste 1, Minneapolis, MN 55405-2819 | 2020-06-08 |
| 1831735141 | Jon Walter Petersen | Counselor | 4136 Queen Ave S Apt 100, Minneapolis, MN 55410-1254 | 2019-11-21 |
| 1790332195 | Esther Swen | Counselor | 2827 Newton Ave N, Minneapolis, MN 55411-1142 | 2019-08-20 |
| 1154976926 | Isuroon | Counselor | 1600 E. Lake St., Suite 1, Minneapolis, MN 55407-1884 | 2019-08-07 |
| 1891354791 | James Clayton | Counselor | 1611 E 32nd St, Minneapolis, MN 55407-1828 | 2019-06-13 |
| 1023592904 | Cody Lewis Oaks | Counselor | 1302 2nd St Ne Ste 210, Minneapolis, MN 55413-2993 | 2018-09-18 |
| 1679847156 | Lavethe Roaitia Liggins | Counselor | 2616 Nicollet Ave South, Minneapolis, MN 55404-0900 | 2012-03-01 |
| 1902196579 | Steven Branco | Counselor | 2323 Benjamin St Ne, Minneapolis, MN 55418-4001 | 2011-04-15 |
| 1447577143 | Kareem Shareef Braxton | Counselor | 227 Colfax Avenue North, Suite 130, Minneapolis, MN 55405 | 2010-04-21 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55404 |
Please comment or provide details below to improve the information on MINNESOTA TRAUMA RECOVERY INSTITUTE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.