Provider Demographics
NPI:1932486057
Name:ALLIANT BEHAVIORAL PEDIATRICS
Entity Type:Organization
Organization Name:ALLIANT BEHAVIORAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA-
Authorized Official - Phone:651-295-7440
Mailing Address - Street 1:201 W TRAVELERS TRL
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2550
Mailing Address - Country:US
Mailing Address - Phone:651-295-7440
Mailing Address - Fax:612-437-4499
Practice Address - Street 1:201 W TRAVELERS TRL
Practice Address - Street 2:SUITE 212
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2550
Practice Address - Country:US
Practice Address - Phone:651-295-7440
Practice Address - Fax:612-437-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-12-12557103K00000X
MN5121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0BI29HUOtherBCBS-MN