Provider Demographics
NPI:1821294372
Name:SAFETY CENTER INC
Entity Type:Organization
Organization Name:SAFETY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:952-884-4882
Mailing Address - Street 1:1216 W 96TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2657
Mailing Address - Country:US
Mailing Address - Phone:952-884-4882
Mailing Address - Fax:952-884-0284
Practice Address - Street 1:1216 W 96TH ST STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2657
Practice Address - Country:US
Practice Address - Phone:952-884-4882
Practice Address - Fax:952-884-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN427098300Medicaid
MN289745OtherMMSI
MN8488139OtherMEDICA
MN136093OtherU-CARE
MN254M0SAOtherBCBS
MN7174505OtherPREFERRED ONE
MN8440070OtherUBH