1649395732 NPI number — SUSAN THOMAS-MCGREGOR M.A., LMFT

Table of content: SUSAN THOMAS-MCGREGOR M.A., LMFT (NPI 1649395732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649395732 NPI number — SUSAN THOMAS-MCGREGOR M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS-MCGREGOR
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS-REILLY
Provider Other First Name:
SUAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649395732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 FIRST AVENUE SOUTH
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-418-5637
Provider Business Mailing Address Fax Number:
612-235-6481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 FIRST AVENUE SOUTH
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-418-5637
Provider Business Practice Location Address Fax Number:
612-235-6481
Provider Enumeration Date:
03/20/2007

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: 106H00000X , with the licence number:  1393 , 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)

  • Identifier: A131613300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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