Provider Demographics
NPI:1134171127
Name:CHOICES PSYCHOTHERAPY, LTD.
Entity type:Organization
Organization Name:CHOICES PSYCHOTHERAPY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:952-544-6806
Mailing Address - Street 1:10201 WAYZATA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1500
Mailing Address - Country:US
Mailing Address - Phone:952-544-6806
Mailing Address - Fax:952-545-0098
Practice Address - Street 1:10201 WAYZATA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1500
Practice Address - Country:US
Practice Address - Phone:952-544-6806
Practice Address - Fax:952-545-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN630079100Medicaid
MN7500691OtherAETNA GROUP
MN060825400Medicaid
MN5G669DAOtherBCBS LICSW GROUP ID
MN620S7CHOtherBCBS LMFT
MN312P4CHOtherBCBS LP GROUP ID
MN804356000OtherMAGELLEN GROUP ID
MNC04202Medicare ID - Type UnspecifiedGROUP MCR NUMBER