1871581793 NPI number — MS. DEBORAH K KRIEGEL LMHC

Table of content: MS. DEBORAH K KRIEGEL LMHC (NPI 1871581793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871581793 NPI number — MS. DEBORAH K KRIEGEL LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRIEGEL
Provider First Name:
DEBORAH
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

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:
1871581793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2410 GRAPE RD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISHAWAKA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46545-3015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-243-9370
Provider Business Mailing Address Fax Number:
574-232-9375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2410 GRAPE RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46545-3015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-243-9370
Provider Business Practice Location Address Fax Number:
574-232-9375
Provider Enumeration Date:
10/13/2005

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: 101YM0800X , with the licence number:  39000432A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 39000432A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000368750 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2301934 . This is a "CIGNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000368750 . This is a "UNICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 267265000 . This is a "MAGELLAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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