1841440195 NPI number — MRS. DEBORAH CARALEE LINK MA LMFT LPCC

Table of content: MRS. DEBORAH CARALEE LINK MA LMFT LPCC (NPI 1841440195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841440195 NPI number — MRS. DEBORAH CARALEE LINK MA LMFT LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINK
Provider First Name:
DEBORAH
Provider Middle Name:
CARALEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA LMFT LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLINS
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
CARALEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841440195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20980 ROGERS DR
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55374-4652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-244-4900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20980 ROGERS DR
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55374-4652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-244-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2008

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:  LPCCCC00085 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: LMFT1986 , 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: 1841440195 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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