Minnetonka Psychology and Wellness

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1130 Issued in MN

Legal business name

MINNETONKA PSYCHOLOGY AND WELLNESS

Practice address

19765 Highway 7
Suite 203
Shorewood, MN 55331

Phone

(952) 767-0442

Fax

(952) 854-1647

NPI assigned

Aug 6, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Roger A. Ballou, PHD

Title

Co-Owner

Phone

(952) 767-0442

Specialties & licenses 1

Addresses

Other names 1

• Minnesota Relationship Center Former legal business name

Locations

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

{
    "created_epoch": "1344211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404950400000",
    "number": "1417204751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19765 HIGHWAY 7",
            "address_2": "SUITE 203",
            "city": "SHOREWOOD",
            "state": "MN",
            "postal_code": "55331",
            "telephone_number": "952-767-0442",
            "fax_number": "952-854-1647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19765 HIGHWAY 7",
            "address_2": "SUITE 203",
            "city": "SHOREWOOD",
            "state": "MN",
            "postal_code": "55331",
            "telephone_number": "952-767-0442",
            "fax_number": "952-854-1647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNETONKA PSYCHOLOGY AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-06",
        "last_updated": "2014-07-10",
        "status": "A",
        "authorized_official_last_name": "BALLOU",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "952-767-0442",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "1130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Relationship Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Sarah M Kim, M.D.
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• Nicole Lovald
• Carlee Elizabeth Meehah, PHARMD
• Susan Barbara Nelson, MA, LPCC
• Nueva Era Healthcare Services, Inc.
• Kelli J O'Shea
• Optage Inc
• PHS Shorewood LLC

• Marriage & Family Therapist in Shorewood, MN
• Providers in Shorewood, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; 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.