Basic Information
Provider Information | |||||||||
NPI: | 1518041896 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCBEAN | ||||||||
FirstName: | ANNE | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
Address2: | CENTER FOR SEXUAL HEALTH, 1300 2ND AVE S, SUITE 180 | ||||||||
City: | MINNEAPOLIS | ||||||||
State: | MN | ||||||||
PostalCode: | 55455 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6126251500 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
Address2: | CENTER FOR SEXUAL HEALTH, 1300 2ND AVE S, SUITE 180 | ||||||||
City: | MINNEAPOLIS | ||||||||
State: | MN | ||||||||
PostalCode: | 55455 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6126251500 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/24/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | LP1974 | MN | X |   | Behavioral Health & Social Service Providers | Psychologist |   | 106H00000X | 0487 | MN | X |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
ID Information
ID | Type | State | Issuer | Description | HP50063 | 01 |   | HEALTH PARTNERS | OTHER | 104855 | 01 |   | UCARE | OTHER | 1007676 | 01 |   | PREFERRED ONE | OTHER | 3T385MC | 01 |   | BLUE CROSS BLUE SHIELD | OTHER | 62-99623 | 01 |   | MEDICA CHOICE | OTHER |