1861629206 NPI number — NORTH CENTRAL PSYCHOLOGICAL CONSULTANTS, INC.

Table of content: (NPI 1861629206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861629206 NPI number — NORTH CENTRAL PSYCHOLOGICAL CONSULTANTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL PSYCHOLOGICAL CONSULTANTS, 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:
1861629206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12760 ABERDEEN ST NE
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
BLAINE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55449-5845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-600-2727
Provider Business Mailing Address Fax Number:
612-656-3031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12760 ABERDEEN ST NE
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55449-5845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-600-2727
Provider Business Practice Location Address Fax Number:
612-656-3031
Provider Enumeration Date:
06/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CLINIC DIRECTOR/OWNER
Authorized Official Telephone Number:
651-600-2727

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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