1386755577 NPI number — MRS. FLORA DIANE ANDERSON-CAPTAIN LPC

Table of content: MRS. FLORA DIANE ANDERSON-CAPTAIN LPC (NPI 1386755577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386755577 NPI number — MRS. FLORA DIANE ANDERSON-CAPTAIN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON-CAPTAIN
Provider First Name:
FLORA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON-CAPTAIN
Provider Other First Name:
F.
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386755577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S ZANG BLVD
Provider Second Line Business Mailing Address:
SUITE 828
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75208-6600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-948-9200
Provider Business Mailing Address Fax Number:
214-948-6776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S ZANG BLVD
Provider Second Line Business Practice Location Address:
SUITE 828
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75208-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-948-9200
Provider Business Practice Location Address Fax Number:
214-948-6776
Provider Enumeration Date:
08/31/2006

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: 101YM0800X , with the licence number:  13245 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001039475 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 62-42824 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 125835 . This is a "VALUE OPTION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3210LC . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1091954 . This is a "CIGNA HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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