=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215581053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN THOMAS MAURER PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2019
-----------------------------------------------------
Last Update Date | 08/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11660 ROUND LAKE BLVD NW
-----------------------------------------------------
City | COON RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55433-2638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-767-3550
-----------------------------------------------------
Fax | 763-767-0912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 SILVER LAKE RD NW
-----------------------------------------------------
City | NEW BRIGHTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55112-1786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-628-9566
-----------------------------------------------------
Fax | 651-628-0411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | LP3846
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------