Provider Demographics
NPI:1164557799
Name:BIOFEEDBACK TRAINING AND TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:BIOFEEDBACK TRAINING AND TREATMENT CENTER, INC.
Other - Org Name:BIOFEEDBACK CENTER OF MINNESOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JEFFREY-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:952-893-9400
Mailing Address - Street 1:5001 AMERICAN BLVD W STE 980
Mailing Address - Street 2:BIOFEEDBACK TRAINING & TREATMENT CENTER, INC.
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1164
Mailing Address - Country:US
Mailing Address - Phone:952-893-9400
Mailing Address - Fax:952-698-3532
Practice Address - Street 1:5001 AMERICAN BLVD W STE 980
Practice Address - Street 2:BIOFEEDBACK TRAINING & TREATMENT CENTER, INC.
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1164
Practice Address - Country:US
Practice Address - Phone:952-893-9400
Practice Address - Fax:952-698-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01458BIOtherBLUE CROSS BLUE SHIELD
MN623080001OtherCIGNA
MN04004001OtherMETROPOLITAN HEALTH PLAN
MN3948OtherHEALTHPARTNERS
MN01-23460OtherMEDICA
MN31800OtherPREFERRED ONE
MN87726OtherUNITED HEALTH CARE
MN7963785-00Medicaid
MN9657479-00Medicaid
MN00014OtherSELECT CARE
MN4544126OtherAETNA
MN109585OtherUCARE
MN3D4274BEOtherBLUE CROSS BLUE SHIELD
MN49-80023OtherMEDICA PRIMARY
MN88G75HAOtherBLUE CROSS BLUE SHIELD
MN3D4274BEOtherBLUE CROSS BLUE SHIELD
MNC00953Medicare ID - Type Unspecified