1902942667 NPI number — CONCEPCION PSYCHOLOGICAL SERVICES

Table of content: (NPI 1902942667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902942667 NPI number — CONCEPCION PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCEPCION PSYCHOLOGICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1902942667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6230 10TH ST N
Provider Second Line Business Mailing Address:
SUITE 310-B
Provider Business Mailing Address City Name:
OAKDALE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55128-6158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-714-2000
Provider Business Mailing Address Fax Number:
651-714-4400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6230 10TH ST N
Provider Second Line Business Practice Location Address:
SUITE 310-B
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55128-6158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-714-2000
Provider Business Practice Location Address Fax Number:
651-714-4400
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONCEPCION
Authorized Official First Name:
JANETTE
Authorized Official Middle Name:
FAYE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
651-714-2000

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP2958 , 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: 103577 . This is a "HEALTH PARTNERS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 453T3CO . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 990991023407 . This is a "PREFERRED ONE MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6190337 . This is a "UNITED BEHAVIORAL HLTH-MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com