Mindbridge Autism LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MINDBRIDGE AUTISM LLC

Practice address

20731 Holyoke Ave # 909
Lakeville, MN 55044-9825

Phone

(763) 528-0300

NPI assigned

Jan 6, 2025

Organization subpart

No

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

Authorized official

Name

Mohamud Boru

Title

Executive Director

Phone

(763) 528-0300

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1736121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736121600000",
    "number": "1992514723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20731 HOLYOKE AVE # 909",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449825",
            "telephone_number": "763-528-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20731 HOLYOKE AVE # 909",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449825",
            "telephone_number": "763-528-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDBRIDGE AUTISM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-06",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A",
        "authorized_official_last_name": "BORU",
        "authorized_official_first_name": "MOHAMUD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "763-528-0300"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Marie Metzger, LADC
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• Patrick Michielutti, DPT
• Meghan R Miller
• Robert B. Miller, DDS
• Mindful Mama Nutrition
• Makayla Marie Minehart
• Minnesota Autism Care LLC
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• Clinic/Center in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.