Provider Demographics
NPI:1184921561
Name:THE NEUROBEHAVIOR CENTER OF MINNESOTA, PLLC
Entity type:Organization
Organization Name:THE NEUROBEHAVIOR CENTER OF MINNESOTA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LICENSED PSYCH
Authorized Official - Phone:952-956-2491
Mailing Address - Street 1:7913 RHODE ISLAND CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1194
Mailing Address - Country:US
Mailing Address - Phone:952-956-2491
Mailing Address - Fax:
Practice Address - Street 1:7913 RHODE ISLAND CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1194
Practice Address - Country:US
Practice Address - Phone:952-956-2491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-19
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5254103G00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty