Active NPI
David Allan Dubois, MASTERS OF ARTS
- Psychologist
- Minneapolis, MN
National Provider Identifier
1720084502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP2840
- Practice address
- 3332 21St Ave S
Minneapolis, MN 55407-2412 - Phone
- (612) 296-9444
- NPI assigned
- Jun 25, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Psychologist | 103T00000X | LP2840 | MN | Primary |
Addresses
Primary practice location
3332 21St Ave S
Minneapolis, MN 55407-2412
Mailing address
3332 21St Ave S
Minneapolis, MN 55407-2412
Phone (612) 296-9444
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0004399432 | Other | MN | AETNA INS. CO. |
| 2347539-00 | Other | MN | MINNESOTA CARE |
| 123475 | Other | MN | BEHAVIORALHEALTHCAREPROVI |
| 030822002 | Other | MN | METROPLIITANHEALTHPLAN |
| 57332-DU | Other | MN | BLUECROSS/BLUESHIELD MN |
| 6276558 | Other | MN | UNITEDBEHAVIORALHEALTH |
| 234753900 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2840 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666310400000",
"number": "1720084502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3332 21ST AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554072412",
"telephone_number": "612-296-9444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3332 21ST AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554072412",
"telephone_number": "612-296-9444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBOIS",
"first_name": "DAVID",
"middle_name": "ALLAN",
"name_prefix": "Mr.",
"credential": "MASTERS OF ARTS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-25",
"last_updated": "2022-10-21",
"certification_date": "2022-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP2840",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA INS. CO.",
"identifier": "0004399432",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MINNESOTA CARE",
"identifier": "2347539-00",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEHAVIORALHEALTHCAREPROVI",
"identifier": "123475",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "METROPLIITANHEALTHPLAN",
"identifier": "030822002",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS/BLUESHIELD MN",
"identifier": "57332-DU",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITEDBEHAVIORALHEALTH",
"identifier": "6276558",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "234753900",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.