Provider Demographics
NPI:1407552565
Name:EMERALD THERAPY LLC
Entity Type:Organization
Organization Name:EMERALD THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MACEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW, PMH-C
Authorized Official - Phone:507-404-0260
Mailing Address - Street 1:7239 FALMOUTH CURV
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-7044
Mailing Address - Country:US
Mailing Address - Phone:507-404-0260
Mailing Address - Fax:
Practice Address - Street 1:7400 LYNDALE AVE S STE 180
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4142
Practice Address - Country:US
Practice Address - Phone:651-504-4297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)