Provider Demographics
NPI:1053419580
Name:HENNEPIN COUNTY
Entity type:Organization
Organization Name:HENNEPIN COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-596-0900
Mailing Address - Street 1:1801 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3793
Mailing Address - Country:US
Mailing Address - Phone:612-596-0900
Mailing Address - Fax:612-879-3824
Practice Address - Street 1:1801 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3793
Practice Address - Country:US
Practice Address - Phone:612-596-0900
Practice Address - Fax:612-879-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01528Medicare ID - Type Unspecified