Provider Demographics
NPI:1558783027
Name:INSIGHT THERAPY LLC
Entity Type:Organization
Organization Name:INSIGHT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:952-451-7003
Mailing Address - Street 1:20425 SUMMERVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DEEPHAVEN
Mailing Address - State:MN
Mailing Address - Zip Code:55331-9228
Mailing Address - Country:US
Mailing Address - Phone:952-451-7003
Mailing Address - Fax:
Practice Address - Street 1:5407 EXCELSIOR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2929
Practice Address - Country:US
Practice Address - Phone:952-451-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 5164251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health