Provider Demographics
NPI:1861105199
Name:PIVOT PSYCHOTHERAPY
Entity type:Organization
Organization Name:PIVOT PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-805-1410
Mailing Address - Street 1:3724 COLFAX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1024
Mailing Address - Country:US
Mailing Address - Phone:612-805-7307
Mailing Address - Fax:612-389-1454
Practice Address - Street 1:4101 HARRIET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1442
Practice Address - Country:US
Practice Address - Phone:612-805-1410
Practice Address - Fax:612-389-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty