1558641555 NPI number — BARBARA (BREE) JOHNSON SEGER LMFT

Table of content: BARBARA (BREE) JOHNSON SEGER LMFT (NPI 1558641555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558641555 NPI number — BARBARA (BREE) JOHNSON SEGER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGER
Provider First Name:
BARBARA (BREE)
Provider Middle Name:
JOHNSON
Provider Name Prefix Text:
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:
SEGER
Provider Other First Name:
BREE
Provider Other Middle Name:
JOHNSON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558641555
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66806 146TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WABASHA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55981-6012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-494-1316
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3265 19TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-6786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-494-1316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2011

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:  2360 , 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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