NPIMap

Organization Active NPI

Bethany Christian Services of Minnesota

  • Professional Counselor
  • Plymouth, MN
National Provider Identifier
1285074039
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
00747 Issued in MN
Legal business name
BETHANY CHRISTIAN SERVICES OF MINNESOTA
Practice address
3131 Fernbrook LN N Ste 204
Plymouth, MN 55447-5337
Phone
(763) 553-0344
Fax
(763) 553-0117
NPI assigned
Jun 26, 2013
Last updated
Mar 31, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BETHANY CHRISTIAN SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gloria Peterson, LICSW
Title
Clinician
Phone
(763) 553-0344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 00747 MN Primary

Addresses

Primary practice location

3131 Fernbrook LN N Ste 204
Plymouth, MN 55447-5337

Mailing address

3131 Fernbrook LN N Ste 204
Plymouth, MN 55447-5337
Phone (763) 553-0344

National Provider Directory

National Provider Directory
Tax ID family
Bethany Christian Services Inc18 organizations share this tax ID, including this one
Part of
Bethany Christian Services Inc

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

3131 Fernbrook Ln N
Ste 204
Plymouth, MN 55447
Phone (763) 553-0344

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585612800000",
    "number": "1285074039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 FERNBROOK LN N STE 204",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475337",
            "telephone_number": "763-553-0344",
            "fax_number": "763-553-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 FERNBROOK LN N STE 204",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475337",
            "telephone_number": "763-553-0344",
            "fax_number": "763-553-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY CHRISTIAN SERVICES OF MINNESOTA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BETHANY CHRISTIAN SERVICES",
        "enumeration_date": "2013-06-26",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "763-553-0344",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "00747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.