1942687397 NPI number — HOPE PSYCHOLOGY PRACTICE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942687397 NPI number — HOPE PSYCHOLOGY PRACTICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPE PSYCHOLOGY PRACTICE, LLC
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:
1942687397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2720 W. 43RD ST.
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-767-9860
Provider Business Mailing Address Fax Number:
612-767-9861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 W. 43RD ST.
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-767-9860
Provider Business Practice Location Address Fax Number:
612-767-9861
Provider Enumeration Date:
05/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RAFFERTY
Authorized Official First Name:
JADE
Authorized Official Middle Name:
BENDEV
Authorized Official Title or Position:
PSYCHOLOGIST/OWNER
Authorized Official Telephone Number:
612-767-9860

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X , with the licence number:  LP5587 , 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)





Copyright © 2007-2025 www.npivalidator.com