Provider Demographics
NPI:1295979664
Name:TWIN CITIES BEHAVIORAL HEALTH, PC
Entity type:Organization
Organization Name:TWIN CITIES BEHAVIORAL HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:I
Authorized Official - Last Name:SHAGALOW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LP
Authorized Official - Phone:952-831-3662
Mailing Address - Street 1:7300 METRO BLVD
Mailing Address - Street 2:SUITE 635
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2303
Mailing Address - Country:US
Mailing Address - Phone:952-831-3662
Mailing Address - Fax:952-831-3559
Practice Address - Street 1:7300 METRO BLVD
Practice Address - Street 2:SUITE 635
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2303
Practice Address - Country:US
Practice Address - Phone:952-831-3662
Practice Address - Fax:952-831-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4413261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1164520284Medicaid