Provider Demographics
NPI:1386405546
Name:ANCHOR WAVE THERAPY
Entity type:Organization
Organization Name:ANCHOR WAVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LMHC
Authorized Official - Phone:561-779-8179
Mailing Address - Street 1:5800 DALE AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2473
Mailing Address - Country:US
Mailing Address - Phone:561-779-8179
Mailing Address - Fax:
Practice Address - Street 1:7831 E BUSH LAKE RD STE 200D
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55439-3164
Practice Address - Country:US
Practice Address - Phone:612-662-7407
Practice Address - Fax:612-500-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health