Provider Demographics
NPI:1164217600
Name:GREAT MINDS THERAPY LLC
Entity type:Organization
Organization Name:GREAT MINDS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BISHARO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-703-7058
Mailing Address - Street 1:333 WASHINGTON AVE N STE 338
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1366
Mailing Address - Country:US
Mailing Address - Phone:612-703-7058
Mailing Address - Fax:612-568-9096
Practice Address - Street 1:333 WASHINGTON AVE N STE 338
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1366
Practice Address - Country:US
Practice Address - Phone:612-703-7058
Practice Address - Fax:612-568-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency