1467827279 NPI number — MRS. MARY ELLEN EMMECK MA, LMFT

Table of content: MRS. MARY ELLEN EMMECK MA, LMFT (NPI 1467827279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467827279 NPI number — MRS. MARY ELLEN EMMECK MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMMECK
Provider First Name:
MARY
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, 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:
1467827279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8401 WAYZATA BLVD STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426-1377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-226-3808
Provider Business Mailing Address Fax Number:
763-544-1008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8401 WAYZATA BLVD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55426-1377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-544-1006
Provider Business Practice Location Address Fax Number:
763-544-1008
Provider Enumeration Date:
12/04/2015

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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