Provider Demographics
NPI:1649538349
Name:DREAMING TREE BEHAVIORAL CENTER, INC
Entity type:Organization
Organization Name:DREAMING TREE BEHAVIORAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAHLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:507-272-5646
Mailing Address - Street 1:4708 MANOR BROOK DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:507-775-6103
Practice Address - Street 1:4708 MANOR BROOK DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3176
Practice Address - Country:US
Practice Address - Phone:507-272-5646
Practice Address - Fax:507-775-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
1669745105253Z00000X
1-107927251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669745105OtherNPI 1