1720418486 NPI number — MR. TIMOTHY RONALD SPRINGER LPC

Table of content: MR. TIMOTHY RONALD SPRINGER LPC (NPI 1720418486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720418486 NPI number — MR. TIMOTHY RONALD SPRINGER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRINGER
Provider First Name:
TIMOTHY
Provider Middle Name:
RONALD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

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:
1720418486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11108 ZEALAND AVE N
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
CHAMPLIN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55316-3594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-420-3749
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11108 ZEALAND AVE N
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
CHAMPLIN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55316-3594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-420-3749
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2013

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: 101Y00000X , with the licence number:  1395 , 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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