1790055416 NPI number — MR. HAROLD REGINALD HUGGINS LICSW

Table of content: MR. HAROLD REGINALD HUGGINS LICSW (NPI 1790055416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790055416 NPI number — MR. HAROLD REGINALD HUGGINS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGGINS
Provider First Name:
HAROLD
Provider Middle Name:
REGINALD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1790055416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1219 MARQUETTE AVE
Provider Second Line Business Mailing Address:
SUITE 390
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55403-2488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-338-9012
Provider Business Mailing Address Fax Number:
612-338-9020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1219 MARQUETTE AVE
Provider Second Line Business Practice Location Address:
SUITE 390
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55403-2488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-338-9012
Provider Business Practice Location Address Fax Number:
612-338-9020
Provider Enumeration Date:
01/11/2012

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: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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