NPIMap

Organization Active NPI

Mind.Body.Self., Inc.

  • Community/Behavioral Health Agency
  • Minneapolis, MN
National Provider Identifier
1013345164
Registry record updated Oct 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
14777 Issued in MN
Legal business name
MIND.BODY.SELF., INC.
Practice address
4749 Chicago Ave Ste 2B
Minneapolis, MN 55407-3561
Phone
(612) 710-6107
NPI assigned
Oct 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kara Merrill, LICSWNPI 1831527860
Title
Clinical Social Worker
Phone
(612) 710-6107

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 14777 MN Primary

Addresses

Primary practice location

4749 Chicago Ave Ste 2B
Minneapolis, MN 55407-3561

Mailing address

4749 Chicago Ave Ste 2B
Minneapolis, MN 55407-3561

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383004800000",
    "number": "1013345164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4749 CHICAGO AVE STE 2B",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4749 CHICAGO AVE STE 2B",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073561",
            "telephone_number": "612-710-6107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND.BODY.SELF., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2013-10-29",
        "status": "A",
        "authorized_official_last_name": "MERRILL",
        "authorized_official_first_name": "KARA",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "612-710-6107",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "14777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.