NPIMap

Organization Active NPI

Avalon Stillware

  • Addiction (Substance Use Disorder) Counselor
  • Stillwater, MN
National Provider Identifier
1346454352
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
830778 Issued in MN
Legal business name
AVALON STILLWARE
Practice address
1825 Curve Crest Blvd W Ste 103
Stillwater, MN 55082-6054
Phone
(612) 326-7555
NPI assigned
May 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Valerie Bundy
Title
Controller
Phone
(612) 326-7555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X 830778 MN Primary

Addresses

Primary practice location

1825 Curve Crest Blvd W Ste 103
Stillwater, MN 55082-6054

Mailing address

550 Main St
New Brighton, MN 55112-3271
Phone (612) 326-7555

National Provider Directory

National Provider Directory
Tax ID family
Avalon - Pine City5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346454352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 MAIN ST",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551123271",
            "telephone_number": "612-326-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 CURVE CREST BLVD W STE 103",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826054",
            "telephone_number": "612-326-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON STILLWARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUNDY",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "612-326-7555"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "830778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.