Provider Demographics
NPI:1477940229
Name:BABYLOVE ALLIANCE LTD.
Entity Type:Organization
Organization Name:BABYLOVE ALLIANCE LTD.
Other - Org Name:THE BABYLOVE ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIR OF CLINICAL PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:612-548-4266
Mailing Address - Street 1:4590 SCOTT TRL
Mailing Address - Street 2:STE 102
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4590 SCOTT TRL
Practice Address - Street 2:STE 102
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3331
Practice Address - Country:US
Practice Address - Phone:651-200-3343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171100000X, 174H00000X, 174N00000X, 367A00000X
MN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty