NPIMap

Organization Active NPI

Blossom Whole Family Therapy & Child Psychology Center, PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Minnetonka, MN
National Provider Identifier
1194059642
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
LP4976 Issued in MN
Legal business name
BLOSSOM WHOLE FAMILY THERAPY & CHILD PSYCHOLOGY CENTER, PLLC
Practice address
10505 Wayzata Blvd Ste 103
Minnetonka, MN 55305-1507
Phone
(952) 545-3300
Fax
(952) 545-3300
NPI assigned
Sep 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Authorized official

Name
Dr. Gretchen Lewis-Snyder, PHD, LPNPI 1174714851
Title
Chief Manager/Psychologist
Phone
(612) 719-5422

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC2200X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X LP4976 MN
Adult Mental Health Clinic/Center 261QM0850X LP4976 MN
Adolescent and Children Mental Health Clinic/Center 261QM0855X LP4976 MN Primary

Addresses

Primary practice location

10505 Wayzata Blvd Ste 103
Minnetonka, MN 55305-1507

Mailing address

10505 Wayzata Blvd Ste 103
Minnetonka, MN 55305-1507
Phone (952) 545-3300

Other names 1

  • Blossom Child Psychology & Behavioral Health Center, PLLC Former legal business name

National Provider Directory

National Provider Directory

Locations

10505 Wayzata Blvd
Ste 103
Minnetonka, MN 55305
Phone (952) 545-3300

11900 Wayzata Blvd
Ste 216E
Minnetonka, MN 55305
Phone (612) 719-5422

Practitioners & affiliated clinicians

Practitioners 2

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": "1254268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1194059642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10505 WAYZATA BLVD STE 103",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051507",
            "telephone_number": "952-545-3300",
            "fax_number": "952-545-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10505 WAYZATA BLVD STE 103",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051507",
            "telephone_number": "952-545-3300",
            "fax_number": "952-545-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM WHOLE FAMILY THERAPY & CHILD PSYCHOLOGY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-30",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "LEWIS-SNYDER",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_title_or_position": "CHIEF MANAGER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "612-719-5422",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LP"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "LP4976",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MN",
            "license": "LP4976",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": "LP4976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blossom Child Psychology & Behavioral Health Center, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Blossom Child Psychology & Behavioral Health Center, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.