Organization Active NPI

Nourish Mental Health & Wellness

  • Psychologist
  • Golden Valley, MN
National Provider Identifier
1992465793
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
NOURISH MENTAL HEALTH & WELLNESS
Practice address
620 Mendelssohn Ave N Ste 156
Golden Valley, MN 55427-4386
Phone
(763) 691-3793
NPI assigned
Dec 21, 2021
Last updated
Dec 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Amy Jean GimbelNPI 1033566583
Title
Owner
Phone
(763) 691-3793

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

620 Mendelssohn Ave N Ste 156
Golden Valley, MN 55427-4386

Mailing address

620 Mendelssohn Ave N Ste 156
Golden Valley, MN 55427-4386
Phone (763) 691-3793

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1992465793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 MENDELSSOHN AVE N STE 156",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274386",
            "telephone_number": "763-691-3793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 MENDELSSOHN AVE N STE 156",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274386",
            "telephone_number": "763-691-3793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOURISH MENTAL HEALTH & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "GIMBEL",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-691-3793"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Golden Valley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.

Verify at the official NPI Registry.