Senior Recovery Program

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

808754-3-CDT Issued in MN

Legal business name

SENIOR RECOVERY PROGRAM

Practice address

2375 Ariel Ave.
Maplewood, MN 55109

Phone

(651) 773-0473

NPI assigned

Oct 21, 2006

Organization subpart

No

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

Authorized official

Name

John T. Clawson

Title

Executive Director

Phone

(651) 773-0473

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Senior Chemical Dependency Counseling and Assistance Association Former legal business name

Locations

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256860800000",
    "number": "1598848939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 ARIEL AVE.",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "55109",
            "telephone_number": "651-773-0473",
            "fax_number": "651-773-9298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 ARIEL AVE.",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "55109",
            "telephone_number": "651-773-0473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR RECOVERY PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-21",
        "last_updated": "2009-10-30",
        "status": "A",
        "authorized_official_last_name": "CLAWSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-773-0473"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "808754-3-CDT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RULE 31 CLINIC DEPT OF HUMAN SERVICES",
            "identifier": "808754",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONSOLIDATED FUND",
            "identifier": "446517200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior Chemical Dependency Counseling and Assistance Association",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2009; 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.