Provider Demographics
NPI:1285942912
Name:DAKOTA THERAPY
Entity type:Organization
Organization Name:DAKOTA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAKOTA
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LADC
Authorized Official - Phone:651-207-5000
Mailing Address - Street 1:1405 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 17
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-9301
Mailing Address - Country:US
Mailing Address - Phone:651-207-5000
Mailing Address - Fax:
Practice Address - Street 1:2278 COUNTY ROAD E W
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-7141
Practice Address - Country:US
Practice Address - Phone:651-207-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00048101Y00000X, 101YM0800X, 101YP2500X
MN301739101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1265769418OtherI HAVE AN OTHER NPI NUMBER FOR WORKING IN ANOTHER CLINIC, NOT MY BUSINESS