Provider Demographics
NPI:1821394099
Name:INTROSPECTIVE PSYCHOTHERAPIES
Entity Type:Organization
Organization Name:INTROSPECTIVE PSYCHOTHERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BHARGAVI
Authorized Official - Middle Name:S
Authorized Official - Last Name:GHATE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-396-6737
Mailing Address - Street 1:5407 EXCELSIOR BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5407 EXCELSIOR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2929
Practice Address - Country:US
Practice Address - Phone:612-396-6737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN136971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty