1861426942 NPI number — JENNIFER OLIVER-KING LMFT

Table of content: JENNIFER OLIVER-KING LMFT (NPI 1861426942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861426942 NPI number — JENNIFER OLIVER-KING LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVER-KING
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1861426942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7026 E FISH LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55311-2832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-239-5055
Provider Business Mailing Address Fax Number:
763-424-8315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7026 E FISH LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55311-2832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-239-5055
Provider Business Practice Location Address Fax Number:
763-424-8315
Provider Enumeration Date:
07/11/2006

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: 106H00000X , with the licence number:  LMFT 1526 , 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: 374896100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP59862 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 906590L . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".