1588835672 NPI number — JOHANNA ALVINA LIMMER MC LPC

Table of content: JOHANNA ALVINA LIMMER MC LPC (NPI 1588835672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588835672 NPI number — JOHANNA ALVINA LIMMER MC LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIMMER
Provider First Name:
JOHANNA
Provider Middle Name:
ALVINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MC LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOWATT
Provider Other First Name:
JOHANNA
Provider Other Middle Name:
ALVINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MC LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588835672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13408 N. 1ST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-687-0510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 W. DUNLAP AVE.
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-943-2999
Provider Business Practice Location Address Fax Number:
602-943-4284
Provider Enumeration Date:
03/17/2008

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:  LPC-132011 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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