1902292089 NPI number — WORAWAN TURNER PSYCHOLOGICAL SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902292089 NPI number — WORAWAN TURNER PSYCHOLOGICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORAWAN TURNER PSYCHOLOGICAL SERVICES LLC
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:
1902292089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4021 VERNON AVE S STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-2801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-222-4491
Provider Business Mailing Address Fax Number:
952-222-4492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4021 VERNON AVE S
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-222-4491
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
WORAWAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-423-5244

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  LP4984 , 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)





Copyright © 2007-2026 www.npivalidator.com