1972829943 NPI number — DEBRA CARTER-BARTH

Table of content: (NPI 1972829943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972829943 NPI number — DEBRA CARTER-BARTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEBRA CARTER-BARTH
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:
HEALTHY MINDS COUNSELING SERVICES, LLC
Provider Other Organization Name Type Code:
3
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:
1972829943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 1ST AVE. N.E.
Provider Second Line Business Mailing Address:
STE 240
Provider Business Mailing Address City Name:
FARIBAULT
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55021-5379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-412-1468
Provider Business Mailing Address Fax Number:
507-331-8677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 1ST AVE NE
Provider Second Line Business Practice Location Address:
STE 240
Provider Business Practice Location Address City Name:
FARIBAULT
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55021-5268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-412-1468
Provider Business Practice Location Address Fax Number:
507-331-8677
Provider Enumeration Date:
04/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER-BARTH
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PSYCHOTHERAPIST / OWNER
Authorized Official Telephone Number:
507-412-1468

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  17263 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X , with the licence number: 17263 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1790923035 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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