Collaboration for Psychological Wellness, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

COLLABORATION FOR PSYCHOLOGICAL WELLNESS, LLC

Practice address

12000 Portland Ave Ste 120
Burnsville, MN 55337-4469

Phone

(612) 276-2462

Fax

(612) 246-3682

NPI assigned

Feb 20, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Tina Dinesh Shah, PSYD, LPNPI 1497991806

Title

Owner/Chief Executive Officer

Phone

(612) 276-2462

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tina Dinesh Shah, PSYD, LP

  • Clinical Psychologist
  • Burnsville, MN
  • NPI 1497991806
  NPD Authorized official

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

{
    "created_epoch": "1582156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1831722594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 PORTLAND AVE STE 120",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374469",
            "telephone_number": "612-276-2462",
            "fax_number": "612-246-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 PORTLAND AVE STE 120",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374469",
            "telephone_number": "612-276-2462",
            "fax_number": "612-246-3682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATION FOR PSYCHOLOGICAL WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-20",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "DINESH",
        "authorized_official_title_or_position": "OWNER/CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "612-276-2462",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Cole, MA, LPCC, LADC
• Mary Cole
• Ryan Patrick Cole, MD
• Chelsea Colegrove
• Madeline Colford, LICSW
• Collective Healing Solutions
• Collective Healing, LLC
• Leo George Colling
• Comfort Bridge Homes Co
• Comfort Transportation

• Clinical Psychologist in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.