Provider Demographics
NPI:1174328033
Name:EARLY INSIGHT THERAPY LLC
Entity type:Organization
Organization Name:EARLY INSIGHT THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUMTAZ
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-346-0646
Mailing Address - Street 1:8030 OLD CEDAR AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1214
Mailing Address - Country:US
Mailing Address - Phone:763-346-0646
Mailing Address - Fax:213-867-8282
Practice Address - Street 1:8030 OLD CEDAR AVE S STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1214
Practice Address - Country:US
Practice Address - Phone:763-346-0646
Practice Address - Fax:213-867-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency