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PRAIRIE ST. JOHN'S CLINIC NPI 1518059690


NPI Information

NPI: 1518059690
Provider Name: PRAIRIE ST. JOHN'S CLINIC
Classification: Counselor - 101Y00000X
Entity Type: Organization
Address:
7616 CURRELL BLVD
SUITE 100
SAINT PAUL, MN
ZIP 55125
Phone: (651) 259-9700
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PRAIRIE ST. JOHN'S CLINIC is a counselor in Saint Paul, MN. The provider is a provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification. PRAIRIE ST. JOHN'S CLINIC NPI is 1518059690. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

7616 CURRELL BLVD
SUITE 100
SAINT PAUL, MN
ZIP 55125-290
Phone: (651) 259-9700
Fax: (651) 259-9740

The provider's authorized official is Jerry W Magnison .
The authorized official title is Chief Financial Officer and has the following contact phone number (701) 476-7221.

The enumeration date for this NPI number is 9/28/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101Y00000XCounselor5063ANORTH DAKOTAYes
2101YM0800XCounselorMental Health5063ANORTH DAKOTAX
3103T00000XPsychologist5063ANORTH DAKOTAX
4103TB0200XPsychologistCognitive & Behavioral5063ANORTH DAKOTAX
5103TC1900XPsychologistCounseling5063ANORTH DAKOTAX
6103TC2200XPsychologistClinical Child & Adolescent5063ANORTH DAKOTAX
7104100000XSocial Worker5063ANORTH DAKOTAX

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1238T5PROTHERMINNESOTAMINNESOTA BLUE CROSS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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