Provider Demographics
NPI:1518162684
Name:PARTNERS IN HEALING OF MINNEAPOLIS, LLC
Entity type:Organization
Organization Name:PARTNERS IN HEALING OF MINNEAPOLIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:763-546-5797
Mailing Address - Street 1:10505 WAYZATA BLVD.,
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5507
Mailing Address - Country:US
Mailing Address - Phone:763-546-5797
Mailing Address - Fax:763-546-5754
Practice Address - Street 1:10505 WAYZATA BLVD.,
Practice Address - Street 2:SUITE #200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5507
Practice Address - Country:US
Practice Address - Phone:763-546-5797
Practice Address - Fax:763-546-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17268101YM0800X, 1041C0700X
MNLP1585103G00000X, 103T00000X, 103TC0700X
MNLP4786103T00000X, 103TB0200X, 103TC1900X, 103TF0000X, 103TH0004X
MN917106H00000X
MN1140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherFEDERAL ID