Provider Demographics
NPI:1073679791
Name:BE SOMEBODY INC
Entity Type:Organization
Organization Name:BE SOMEBODY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SEVERANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LP
Authorized Official - Phone:651-777-3336
Mailing Address - Street 1:11550 STILLWATER BLVD N STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8613
Mailing Address - Country:US
Mailing Address - Phone:651-777-3336
Mailing Address - Fax:
Practice Address - Street 1:11550 STILLWATER BLVD N STE 102
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8613
Practice Address - Country:US
Practice Address - Phone:651-777-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3637103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41D04SEOtherBCBS GROUP NUMBER