1134281231 NPI number — MS. SUSAN E BOYER LMFT CEAP

Table of content: MS. SUSAN E BOYER LMFT CEAP (NPI 1134281231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134281231 NPI number — MS. SUSAN E BOYER LMFT CEAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYER
Provider First Name:
SUSAN
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT CEAP
Provider Gender Code:
F

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:
1134281231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4445 W 77TH ST STE 234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-5146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-945-9179
Provider Business Mailing Address Fax Number:
952-835-1995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4445 W 77TH ST STE 234
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-5146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-945-9179
Provider Business Practice Location Address Fax Number:
952-835-1995
Provider Enumeration Date:
12/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1273 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 670190600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".