1750440715 NPI number — ANDREW ROBERT JOHNSON LMFT

Table of content: ANDREW ROBERT JOHNSON LMFT (NPI 1750440715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750440715 NPI number — ANDREW ROBERT JOHNSON LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ANDREW
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1750440715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
512 2ND ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLMAR
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-231-1744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 6TH STREET SE
Provider Second Line Business Practice Location Address:
WOODLAND CENTERS
Provider Business Practice Location Address City Name:
WILLMAR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56201-4675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-235-4613
Provider Business Practice Location Address Fax Number:
855-625-7406
Provider Enumeration Date:
12/06/2006

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:  1083 , 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: 467S1JO . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 172403 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1032861 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 570024800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com