1346518859 NPI number — MRS. CATHERINE ANN MACDONALD LMFT

Table of content: MRS. CATHERINE ANN MACDONALD LMFT (NPI 1346518859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346518859 NPI number — MRS. CATHERINE ANN MACDONALD LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACDONALD
Provider First Name:
CATHERINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PORTHAN
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1346518859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 WILLSON RD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55424-1332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-803-5546
Provider Business Mailing Address Fax Number:
952-920-2461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 WILLSON RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55424-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-803-5546
Provider Business Practice Location Address Fax Number:
952-920-2461
Provider Enumeration Date:
12/12/2011

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: 106H00000X , with the licence number:  1683 , 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)





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