Active NPI
Wyatt Thomas Brooks, MHP, RBT
- Behavior Technician
- Minnetonka, MN
National Provider Identifier
1508535162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-20-135436
- Practice address
- 10273 Yellow Circle Dr
Minnetonka, MN 55343-9144 - Phone
- (952) 401-9359
- NPI assigned
- Sep 8, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-20-135436 | MN | Primary |
Addresses
Primary practice location
10273 Yellow Circle Dr
Minnetonka, MN 55343-9144
Mailing address
1918 Newton Ave N
Minneapolis, MN 55411-2461
Phone (608) 436-1463
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RBT-20-135436 | Other | MN | BEHAVIOR ANALYST CERTIFICATION BOARD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-20-135436 | MN | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631059200000",
"number": "1508535162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1918 NEWTON AVE N",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554112461",
"telephone_number": "608-436-1463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10273 YELLOW CIRCLE DR",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439144",
"telephone_number": "952-401-9359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "WYATT",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"credential": "MHP, RBT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-08",
"last_updated": "2021-09-08",
"certification_date": "2021-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MN",
"license": "RBT-20-135436",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEHAVIOR ANALYST CERTIFICATION BOARD",
"identifier": "RBT-20-135436",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.