Unknown Individual – Marriage & Family Therapist, NPI 1629246236

Unknown Individual is a healthcare provider. based in White bear lake, Minnesota. specializing in Marriage & Family Therapist. They hold a License No. 1633 (MN). The NPI Number for Unknown Individual is 1629246236

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1629246236
Phone
(651) 402-8883
Address
4858 BANNING AVE
Deactivation Date
3 April 2025
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 4858, Banning Avenue, White Bear Lake, Ramsey County, Minnesota, 55110, United States

    WHITE BEAR LAKE, MN 551102870

    Phone: (651) 402-8883

    Fax: (651) 653-7033

    Type: Mailing

  • 1485, 81st Avenue Northeast, Spring Lake Park, Anoka County, Minnesota, 55432, United States

    SPRING LAKE PARK, MN 554322111

    Phone: (763) 780-0784

    Fax: (763) 780-0784

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55110)

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Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1629246236 on file in the registry.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Marriage & Family Therapist in the directory — Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on White Bear Lake, Minnesota.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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