Basic Information
| Provider Information | |||||||||
| NPI: | 1720115876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRAIT | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Credential: | PSY.D., L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122625000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 STATE AVE | ||||||||
| Address2: | |||||||||
| City: | FARIBAULT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073343921 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | LP4395 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | LP4395 | MN | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 143125 | 01 | MN | UCARE | OTHER | 61-51323 | 01 | MN | UNITED BEHAVIORAL HEALTH | OTHER | 921001031652 | 01 | MN | PREFERRED ONE | OTHER | HP37282 | 01 | MN | HEALTHPARTNERS | OTHER | 162324900 | 05 | MN | MEDICAID | 320J3TI | 01 | MN | BCBS OF MN | OTHER |