NPIMap

Organization Active NPI

Institute for Therapy & Behavior Change, LTD.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Edina, MN
National Provider Identifier
1548488331
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
INSTITUTE FOR THERAPY & BEHAVIOR CHANGE, LTD.
Practice address
3919 W 44TH St Ste 200
Edina, MN 55424-1032
Phone
(952) 922-1977
Fax
(952) 922-1980
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Kathleen Conlon, LICSWNPI 1407075401
Title
Co-Owner
Phone
(952) 922-1977

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

3919 W 44TH St Ste 200
Edina, MN 55424-1032

Mailing address

3919 W 44TH St Ste 200
Edina, MN 55424-1032
Phone (952) 922-1977

Other identifiers 1

IdentifierTypeStateIssuer
07678INOtherMNBLUE SHIELD GROUP NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1548488331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 W 44TH ST STE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554241032",
            "telephone_number": "952-922-1977",
            "fax_number": "952-922-1980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 W 44TH ST STE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554241032",
            "telephone_number": "952-922-1977",
            "fax_number": "952-922-1980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR THERAPY & BEHAVIOR CHANGE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONLON",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "952-922-1977",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "07678IN",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.