Provider Demographics
NPI:1598303794
Name:MINNESOTA TRAUMA RECOVERY INSTITUTE
Entity Type:Organization
Organization Name:MINNESOTA TRAUMA RECOVERY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:EMMA-RYAN
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-587-5044
Mailing Address - Street 1:822 S 3RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1200
Mailing Address - Country:US
Mailing Address - Phone:612-217-4002
Mailing Address - Fax:
Practice Address - Street 1:822 S 3RD ST STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1200
Practice Address - Country:US
Practice Address - Phone:612-287-1600
Practice Address - Fax:612-287-1616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RS EDEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty