1083749402 NPI number — ANN SELMA ALPERN PHD LMHC

Table of content: ANN SELMA ALPERN PHD LMHC (NPI 1083749402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083749402 NPI number — ANN SELMA ALPERN PHD LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALPERN
Provider First Name:
ANN
Provider Middle Name:
SELMA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD LMHC
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:
1083749402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIVERSITY PLACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98464-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-565-3759
Provider Business Mailing Address Fax Number:
253-857-8358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4109 BRIDGEPORT WAY WEST
Provider Second Line Business Practice Location Address:
SUITE D 3
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-4328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-565-3759
Provider Business Practice Location Address Fax Number:
253-857-8358
Provider Enumeration Date:
02/23/2007

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: 101Y00000X , with the licence number:  LH00004286 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AL4667 . This is a "REGENCE BLUESHIELD" identifier . This identifiers is of the category "OTHER".




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