1134171127 NPI number — CHOICES PSYCHOTHERAPY, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134171127 NPI number — CHOICES PSYCHOTHERAPY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICES PSYCHOTHERAPY, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134171127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10201 WAYZATA BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55305-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-544-6806
Provider Business Mailing Address Fax Number:
952-545-0098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10201 WAYZATA BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55305-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-544-6806
Provider Business Practice Location Address Fax Number:
952-545-0098
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
952-544-6806

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 630079100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7500691 . This is a "AETNA GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 060825400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5G669DA . This is a "BCBS LICSW GROUP ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 620S7CH . This is a "BCBS LMFT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 312P4CH . This is a "BCBS LP GROUP ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 804356000 . This is a "MAGELLEN GROUP ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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