Project Fresh Start Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4593 Issued in MN

Legal business name

PROJECT FRESH START INC.

Practice address

2854 Columbus Ave
Minneapolis, MN 55407-1324

Phone

(612) 354-7904

NPI assigned

May 24, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Pamels Robin Zeller

Title

Executive Director

Phone

(651) 399-3307

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495584000000",
    "number": "1427586296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7367",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554070367",
            "telephone_number": "651-399-3307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2854 COLUMBUS AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071324",
            "telephone_number": "612-354-7904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROJECT FRESH START INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-24",
        "last_updated": "2017-05-24",
        "status": "A",
        "authorized_official_last_name": "ZELLER",
        "authorized_official_first_name": "PAMELS",
        "authorized_official_middle_name": "ROBIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-399-3307",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4593",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "MN",
            "license": "23792",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2017; 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.