South Metro Therapy LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

CC00807 Issued in MN

Legal business name

SOUTH METRO THERAPY LLC

Practice address

9202 202ND St W Ste 201
Lakeville, MN 55044-7917

Phone

(952) 567-3399

NPI assigned

Oct 13, 2015

Last updated

Oct 13, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nergis Petersen

Title

Therapist

Phone

(952) 567-3399

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1144691411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17898 179TH TRL W",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550447248",
            "telephone_number": "952-250-4072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9202 202ND ST W STE 201",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550447917",
            "telephone_number": "952-567-3399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH METRO THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-13",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "NERGIS",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "952-567-3399"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MN",
            "license": "CC00807",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": "CC00807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Somerville
• Melissa Catherine Gabbert Soukup, PHARM. D.
• Steven John Soukup
• Soul Solace Massage LLC
• South Metro Care Services
• South Suburban Eyecare Specialists PA
• Hannah M Spande, BCBA
• Morgan Speegle, LMT
• Karie Frances Spry
• Starlight Transport Inc

• Adolescent and Children Mental Health Clinic/Center in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Adolescent and Children Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; 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.