Blue Iris Therapy, PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

943 Issued in MN

Legal business name

BLUE IRIS THERAPY, PLLC

Practice address

6437 Lyndale Ave S
Suite 101
Richfield, MN 55423-1465

Phone

(612) 455-4040

Fax

(612) 455-4041

NPI assigned

Jun 1, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Grant D Chikazawa-Nelson, PHD

Title

Owner/Psychotherapist

Phone

(612) 655-9776

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Blue Iris Center for Therapeutic Services, LLC Former legal business name

Locations

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

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1649564188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6437 LYNDALE AVE S",
            "address_2": "SUITE 101",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231465",
            "telephone_number": "612-455-4040",
            "fax_number": "612-455-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6437 LYNDALE AVE S",
            "address_2": "SUITE 101",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231465",
            "telephone_number": "612-455-4040",
            "fax_number": "612-455-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE IRIS THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-01",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "CHIKAZAWA-NELSON",
        "authorized_official_first_name": "GRANT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "612-655-9776",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA-UBH",
            "identifier": "227349918",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "540521",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U-CARE",
            "identifier": "143645",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529100300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHP",
            "identifier": "550045 02",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "69B22CH",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Iris Center for Therapeutic Services, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Joyce Biddle
• Sydney Marie Biel, OTR
• Lacy Ann Bindl, O.D.
• Emily Grace Bliss
• Blue Iris Center for Therapeutic Services
• Mia Blundetto, DCM, L.AC
• Cori Christina Boehm-Peterson, LICSW
• Kristina Stewart Bonello, LICSW
• Donna Bonicatto, LICSW
• Marlene Bonilla Alicea, DPM

• Community/Behavioral Health Agency in Richfield, MN
• Providers in Richfield, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; 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.