Provider Demographics
NPI:1235512351
Name:PAREKH, NATASHA MANISH (PHD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MANISH
Last Name:PAREKH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 TWELVE OAKS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-4401
Mailing Address - Country:US
Mailing Address - Phone:952-209-1510
Mailing Address - Fax:
Practice Address - Street 1:700 TWELVE OAKS CENTER DR
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:952-209-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X, 103T00000X
MN6166103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660631Medicaid
NE47037660624Medicaid
NE10026139700Medicaid