Attachment and Family Center of Minnesota
Organization Active NPI Clinical Child & Adolescent Psychologist · Chaska, MN
NPI 1053485904 · NPPES record last updated May 10, 2020
Key facts
- NPI
- 1053485904
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Child & Adolescent Psychologist 103TC2200X
- Legal business name
- ATTACHMENT AND FAMILY CENTER OF MINNESOTA
- Practice address
- 102 N Chestnut St
Chaska, MN 55318-1918 - Phone
- (952) 475-2818
- Fax
- (952) 475-3356
- NPI assigned
- Nov 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Anthony Todd Nichols
- Title
- Exescutive Director
- Phone
- (952) 234-4632
Practitioners 6
-
Constance Marie Dummer, LP, LMFT, RPT-S
-
Anna Ludowese, DNP, PMHNP-BC
-
Anthony Todd Nichols, PHD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071001000100 | MN | Part B Supplier - Clinic/Group Practice | 1052406444 |
Receives reassigned benefits from 4 practitioners Practice locations: Chaska, MN |
National Provider Directory
Locations
102 N Chestnut St
Chaska, MN 55318
Phone (952) 234-4632
1620 Oak Park Ave N
Minneapolis, MN 55411
Phone (952) 475-2818
18322 Minnetonka Blvd
Ste C
Wayzata, MN 55391
Phone (952) 475-2818
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | |||
| Clinical Child & Adolescent Psychologist |
103TC2200X | Yes | ||
| Clinical Social Worker |
1041C0700X | |||
| Marriage & Family Therapist |
106H00000X |
Addresses
Primary practice location
102 N Chestnut St
Chaska, MN 55318-1918
Mailing address
102 N Chestnut St
Chaska, MN 55318-1918
Phone (952) 475-2818
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 118447400 | Medicaid | MN | |
| 05142700 | Medicaid | MN |
Other names
- Family Attachment and Counseling Center
Other providers in Chaska, MN
- Lauren Ashley Ashburn
- Mevhibe Meral Atay
- Nolan Brent Atchison
- Sarah Ann Atkins
- Atlas Surgery Center, LLC
- Auburn Manor
- Auburn Manor
- Autism Assistance & Therapy Center, Inc.
- Jason Lee Baumberger
- Jessica Beck
All providers in Chaska, MN · Clinical Child & Adolescent Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.