1699363986 NPI number — AMANDA CAROLE LUCIUS MA LMFT

Table of content: AMANDA CAROLE LUCIUS MA LMFT (NPI 1699363986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699363986 NPI number — AMANDA CAROLE LUCIUS MA LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCIUS
Provider First Name:
AMANDA
Provider Middle Name:
CAROLE
Provider Name Prefix Text:
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:
WESTLIE
Provider Other First Name:
AMANDA
Provider Other Middle Name:
CAROLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699363986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5860 BAKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55345-5903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-767-4200
Provider Business Mailing Address Fax Number:
952-767-4211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 11TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55912-3316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-767-4200
Provider Business Practice Location Address Fax Number:
952-767-4211
Provider Enumeration Date:
01/04/2021

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

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

  • Identifier: 4070 . This is a "MINNESOTA BOARD OF MARRIAGE AND FAMILY THERAPY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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