1164533212 NPI number — ORCHARD PSYCHOLOGISTS, PLLC

Table of content: (NPI 1164533212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164533212 NPI number — ORCHARD PSYCHOLOGISTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORCHARD PSYCHOLOGISTS, PLLC
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:
1164533212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 PARNELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-848-2297
Provider Business Mailing Address Fax Number:
952-929-6774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7101 YORK AVE S
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-4469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-848-2297
Provider Business Practice Location Address Fax Number:
855-582-5034
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ORCHARD
Authorized Official First Name:
ANN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
952-848-2297

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP4178 , 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: 203T3OR . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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