Tubman

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

800487-2-MCH Issued in MN

Legal business name

TUBMAN

Practice address

4432 Chicago Ave S
Minneapolis, MN 55407-3519

Phone

(612) 870-2444

Fax

(612) 870-2428

NPI assigned

Mar 7, 2007

Organization subpart

No

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

Authorized official

Name

Beverly Dusso

Title

Executive Director

Phone

(612) 767-6690

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Chrysalis Former legal business name

Tax ID family

Chrysalis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tubman

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1376655159
  NPD tax ID

Practitioners 1

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

• April Dejarlais, MPS, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Minneapolis, MN
  • NPI 1679033138
  NPD (past)

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226448000000",
    "number": "1295866911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4432 CHICAGO AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073519",
            "telephone_number": "612-870-2444",
            "fax_number": "612-870-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4432 CHICAGO AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073519",
            "telephone_number": "612-870-2444",
            "fax_number": "612-870-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUBMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-11-12",
        "status": "A",
        "authorized_official_last_name": "DUSSO",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-767-6690"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "800487-2-MCH",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MN",
            "license": "800488-3-CDT",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "575255800",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257080700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9026CH",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chrysalis",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Daniel Tsolak
• Dean T Tsukayama, MD
• Andy A Tu, DDS
• Margaret Tu, D.C.
• Shanna Tubbs, DPT
• Tubman
• Tubman
• David E Tubman, M.D.
• Kathryn Marie Tubman, MS, CCC-SLP
• Cecilia L Tubolino, NNP

• Mental Health Clinic/Center (Including Community Mental Health Center) in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2008; 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.