Minnesota Evidence-Based Therapy & Assessment Clinic, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MINNESOTA EVIDENCE-BASED THERAPY & ASSESSMENT CLINIC, LLC

Practice address

5413 Nicollet Ave S
#164
Minneapolis, MN 55419-1927

Phone

(612) 308-2508

Fax

(612) 486-9497

NPI assigned

Mar 16, 2015

Organization subpart

No

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

Authorized official

Name

Jacqueline Wright, LICSWNPI 1336462977

Title

Owner/Therapist

Phone

(612) 308-2508

Specialties & licenses 1

Addresses

Other names 1

• META Clinic, LLC Doing business as

Locations

Practitioners 2

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

• Jacqueline Marie Wright, LICSW

  • Clinical Social Worker
  • Minneapolis, MN
  • NPI 1336462977
  NPD Authorized official
• Lynsey R Miron, PHD, LP

  • Clinical Psychologist
  • Inver Grove Heights, MN
  • NPI 1336638097
  NPD (past)

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1487047346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5413 NICOLLET AVE S",
            "address_2": "#164",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191927",
            "telephone_number": "612-308-2508",
            "fax_number": "612-486-9497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5413 NICOLLET AVE S",
            "address_2": "#164",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191927",
            "telephone_number": "612-308-2508",
            "fax_number": "612-486-9497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA EVIDENCE-BASED THERAPY & ASSESSMENT CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-16",
        "last_updated": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "612-308-2508",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "META Clinic, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; 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.