Resilient Fusion

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

RESILIENT FUSION

Practice address

3662 Pointe Pass NW
Prior Lake, MN 55372-4555

Phone

(952) 210-2724

NPI assigned

Apr 4, 2024

Organization subpart

No

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

Authorized official

Name

Latasha Peterson, LPCC

Title

Owner

Phone

(952) 210-2724

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1063264612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3662 POINTE PASS NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553724555",
            "telephone_number": "952-210-2724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3662 POINTE PASS NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553724555",
            "telephone_number": "952-210-2724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESILIENT FUSION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "LATASHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-210-2724",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Adult Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.