1194948570 NPI number — MRS. MINA ANN DICKSON LPC LMFT

Table of content: MRS. MINA ANN DICKSON LPC LMFT (NPI 1194948570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194948570 NPI number — MRS. MINA ANN DICKSON LPC LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKSON
Provider First Name:
MINA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC LMFT
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:
1194948570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1525 12TH ST
Provider Second Line Business Mailing Address:
SUITE 4A
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-999-6809
Provider Business Mailing Address Fax Number:
805-435-7434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 4A
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-999-6809
Provider Business Practice Location Address Fax Number:
805-435-7434
Provider Enumeration Date:
04/11/2007

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: 101YP2500X , with the licence number:  C1938 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com