Provider Demographics
NPI:1992567077
Name:BLUE HORN BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:BLUE HORN BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATUMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUHAD
Authorized Official - Suffix:
Authorized Official - Credentials:CNP, PMHNP
Authorized Official - Phone:612-735-0524
Mailing Address - Street 1:5069 151ST ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6991
Mailing Address - Country:US
Mailing Address - Phone:612-735-0524
Mailing Address - Fax:
Practice Address - Street 1:860 BLUE GENTIAN RD STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1567
Practice Address - Country:US
Practice Address - Phone:612-990-5029
Practice Address - Fax:612-895-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty