=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841590767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE T COUNSELING, CONSULTATION, TRAINING, PUBLISHING & PRODUCTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2010
-----------------------------------------------------
Last Update Date | 10/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2854 HIGHWAY 55 SUITE 130
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55121-1776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-842-3327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2854 HIGHWAY 55 SUITE 130
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55121-1776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-842-3327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DAVID JAY MATHEWS
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 651-528-9410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 1470340
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------