Individual provider Active NPI

Breana Foley

  • Marriage & Family Therapist
  • Minneapolis, MN
National Provider Identifier
1104490242
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
5407 Excelsior Blvd Ste B5407
Minneapolis, MN 55416-2929
Phone
(612) 787-2832
NPI assigned
May 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X Primary

Addresses

Primary practice location

5407 Excelsior Blvd Ste B5407
Minneapolis, MN 55416-2929

Mailing address

5407 Excelsior Blvd Ste B5407
Minneapolis, MN 55416-2929
Phone (612) 787-2832

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240411002743 MN Practitioner - Marriage and Family Therapist 8224477146 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4316MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Serenity Therapy LLC Current Accepting new patients
West End Therapy Clinic LLC Marriage & Family Therapist CurrentSince Mar 1, 2024 Accepting new patients

Locations

6465 Wayzata Blvd
Ste 710
St Louis Park, MN 55426
Phone (612) 735-8002

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1104490242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5407 EXCELSIOR BLVD STE B5407",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554162929",
            "telephone_number": "612-787-2832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5407 EXCELSIOR BLVD STE B5407",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554162929",
            "telephone_number": "612-787-2832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOLEY",
        "first_name": "BREANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-13",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.