Provider Demographics
NPI:1083858989
Name:PARTNERS IN HEALING OF MINNEAPOLIS
Entity Type:Organization
Organization Name:PARTNERS IN HEALING OF MINNEAPOLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
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:55305-1502
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:55305-1502
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:2009-04-23
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1585103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680001035Medicare UPIN