Prime Autism Center Inc

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

Legal business name

PRIME AUTISM CENTER INC

Practice address

322 W Lake St Ste 207
Minneapolis, MN 55408-5202

Phone

(612) 900-2854

NPI assigned

May 28, 2021

Organization subpart

No

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

Authorized official

Name

Shafici D Ali

Title

President

Phone

(612) 900-2854

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1622160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1396311577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 W LAKE ST STE 207",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554085202",
            "telephone_number": "612-900-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 W LAKE ST STE 207",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554085202",
            "telephone_number": "612-900-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME AUTISM CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-28",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "SHAFICI",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-900-2854"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Priess, LICSW
• Eliza Priest
• Shane Prijatel-Spare
• Primary Behavioral Health Clinic, Inc.
• Primary Initiative Care LLC
• Prime Growth Behavior Services Inc.
• Prime Healing Inc
• Prime Health Professional Corporation
• Prime Health Services Inc
• Prime Health Wellness LLC

• Cognitive & Behavioral Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Cognitive & Behavioral Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.