1396265799 NPI number — MR. JOSEPH MARINER KINDRED LMFT

Table of content: MR. JOSEPH MARINER KINDRED LMFT (NPI 1396265799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396265799 NPI number — MR. JOSEPH MARINER KINDRED LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINDRED
Provider First Name:
JOSEPH
Provider Middle Name:
MARINER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DHARA
Provider Other First Name:
JOSEPH
Provider Other Middle Name:
OSTAVIOLOUIS SURANO
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396265799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
E2498 350TH AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENOMONIE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54751-6212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-726-1688
Provider Business Mailing Address Fax Number:
207-708-5352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
E2498 350TH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENOMONIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54751-6212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-726-1688
Provider Business Practice Location Address Fax Number:
207-708-5352
Provider Enumeration Date:
06/27/2017

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:  571-228 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100093715 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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