NPIMap

Organization Active NPI

KWST Targeted Behavioral Development Group

  • Case Manager/Care Coordinator
  • Minneapolis, MN
National Provider Identifier
1376151977
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Legal business name
KWST TARGETED BEHAVIORAL DEVELOPMENT GROUP
Practice address
333 Washington Ave N Ste 323
Minneapolis, MN 55401-1366
Phone
(612) 518-6009
NPI assigned
Jul 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Authorized official

Name
Keary Wayne Saffold, MED
Title
President
Phone
(612) 518-6009

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior TechnicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106S00000X
Case Manager/Care CoordinatorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 171M00000X Primary
Community Health WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 172V00000X
Student Health Clinic/Center 261QS1000X

Addresses

Primary practice location

333 Washington Ave N Ste 323
Minneapolis, MN 55401-1366

Mailing address

333 Washington Ave N Ste 323
Minneapolis, MN 55401-1366
Phone (612) 518-6009

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmason@inbox.com Direct

National Provider Directory

National Provider Directory

Locations

333 Washington Ave N
Ste 323
Minneapolis, MN 55401
Phone (612) 518-6009

333 Washington Ave N
Ste 332
Minneapolis, MN 55401

NPI Registry JSON

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

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1376151977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 WASHINGTON AVE N STE 323",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554011366",
            "telephone_number": "612-518-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 WASHINGTON AVE N STE 323",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554011366",
            "telephone_number": "612-518-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KWST TARGETED BEHAVIORAL DEVELOPMENT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-20",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "SAFFOLD",
        "authorized_official_first_name": "KEARY",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-518-6009",
        "authorized_official_credential": "MED"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmason@inbox.com",
            "affiliation": "N",
            "endpointDescription": "Clinical Director contact",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "333 Washington Ave N Ste 332",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554011366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.