1194867432 NPI number — MARLENE ANN BEECROFT MSSW, LICSW

Table of content: MARLENE ANN BEECROFT MSSW, LICSW (NPI 1194867432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194867432 NPI number — MARLENE ANN BEECROFT MSSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEECROFT
Provider First Name:
MARLENE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILES
Provider Other First Name:
MARLENE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194867432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 COON RAPIDS BOULEVARD
Provider Second Line Business Mailing Address:
FAMILY LIFE MENTAL HEALTH CENTER
Provider Business Mailing Address City Name:
COON RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-427-7964
Provider Business Mailing Address Fax Number:
763-427-7976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 COON RAPIDS BOULEVARD
Provider Second Line Business Practice Location Address:
FAMILY LIFE MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
COON RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-427-7964
Provider Business Practice Location Address Fax Number:
763-427-7976
Provider Enumeration Date:
02/13/2007

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 , with the licence number:  LP01724 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: 01724 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 150322 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP30584 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6C871BE . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1011797 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 472357100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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