Provider Demographics
NPI:1104307800
Name:MIDWEST CENTER FOR TRAUMA & EMOTIONAL HEALING
Entity type:Organization
Organization Name:MIDWEST CENTER FOR TRAUMA & EMOTIONAL HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PH.D. PSYCHOLOGIST, CLINICAL DIRECT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:952-232-7712
Mailing Address - Street 1:16204 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3405
Mailing Address - Country:US
Mailing Address - Phone:952-232-7712
Mailing Address - Fax:952-934-3010
Practice Address - Street 1:16204 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3405
Practice Address - Country:US
Practice Address - Phone:952-232-7712
Practice Address - Fax:952-934-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health