Bonnie Brae Psychotherapy LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BONNIE BRAE PSYCHOTHERAPY LLC

Practice address

821 Raymond Ave Ste 440
Saint Paul, MN 55114-1525

Phone

(612) 552-7023

NPI assigned

Sep 15, 2020

Organization subpart

No

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

Authorized official

Name

Michael SchaefferNPI 1336422161

Title

Owner

Phone

(612) 618-6268

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Michael Christopher Schaeffer

  • Clinical Social Worker
  • Saint Paul, MN
  • NPI 1336422161
  NPD Authorized official

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1831704816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 RAYMOND AVE STE 440",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 RAYMOND AVE STE 440",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141525",
            "telephone_number": "612-552-7023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNIE BRAE PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-15",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "SCHAEFFER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-618-6268"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336422161",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bond Psychotherapy, LLC
• Abby Jean Bongers
• David Warren Bonham, MD
• Leah Louise Bonine
• Ivy Bonneville
• Roberta Lee Bonrud, RRT
• Elizabeth Bonson, M.D.
• Jenna Booher
• Irving Boone, PH.D
• Grant Edward Booth, MSW, LICSW, ACSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.