Crystal Wellness Center LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

CRYSTAL WELLNESS CENTER LLC

Practice address

9001 E Bloomington Fwy Ste 147
Bloomington, MN 55420-3450

Phone

(952) 658-6845

NPI assigned

Feb 25, 2020

Organization subpart

No

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

Authorized official

Name

Ahmedweli Farah

Title

Owner/Administrator

Phone

(952) 658-6845

Specialties & licenses 4

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kazoua Vang

  • Marriage & Family Therapist
  • Minneapolis, MN
  • NPI 1336795301
  NPD (past)

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1194359547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9001 E BLOOMINGTON FWY STE 147",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554203450",
            "telephone_number": "952-658-6845",
            "fax_number": "612-295-0381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9001 E BLOOMINGTON FWY STE 147",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554203450",
            "telephone_number": "952-658-6845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "FARAH",
        "authorized_official_first_name": "AHMEDWELI",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "952-658-6845"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Crowell
• Sarah Dawn Crowley
• Rayna E Crumble
• Diana Cruz
• Pearl Cruz
• Alexis Cuello
• Mary Gurska Cuff, BSN,RN,LSN
• Kelsey Lynn Culhane, CNP
• Constance L Cullen, MD
• Jessica Cumatz

• Adult Mental Health Clinic/Center in Bloomington, MN
• Providers in Bloomington, 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 Jul 17, 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.