Provider Demographics
NPI:1013700921
Name:SWEET SPECTRUM THERAPY LLC
Entity type:Organization
Organization Name:SWEET SPECTRUM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-469-2025
Mailing Address - Street 1:8500 NORMANDALE LAKE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-3805
Mailing Address - Country:US
Mailing Address - Phone:507-469-2025
Mailing Address - Fax:
Practice Address - Street 1:8500 NORMANDALE LAKE BLVD STE 350
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-3805
Practice Address - Country:US
Practice Address - Phone:507-469-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health