1629117452 NPI number — AMETHYST COUNSELING SERVICES, INC.

Table of content: (NPI 1629117452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629117452 NPI number — AMETHYST COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMETHYST COUNSELING SERVICES, INC.
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:
1629117452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 SILVER LAKE RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRIGHTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55112-9301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-633-4532
Provider Business Mailing Address Fax Number:
651-633-9311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 SILVER LAKE RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRIGHTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55112-9301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-633-4532
Provider Business Practice Location Address Fax Number:
651-633-9311
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
JON
Authorized Official Title or Position:
PROGRAM COORIDANATOR
Authorized Official Telephone Number:
651-633-4532

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  820357100 , 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: 97081 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8443304 . This is a "UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 820357100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18676 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4269AM . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 101961 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8460134 . This is a "UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8460135 . This is a "UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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