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NPI Code Detail

MEDICARE: DAVID GLENN RUNION L.M.F.T.

MEDICARE: DAVID GLENN RUNION L.M.F.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist1256MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
103N72RUOTHERMNBLUE CROSS BLUE SHIELD
2273113OTHERMNCOMPSYCH EAP
3136100OTHERMNBHP - UCARE
4HP49304OTHERMNHEALTH PARTNERS

General Provider Information

NPI Number : 1083773220
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID GLENN RUNION L.M.F.T.
Provider Business Mailing Address
First Line : 2115 COUNTY ROAD D E
Second Line : SUITE B
City : MAPLEWOOD
State : MN
Zip : 55109-5353
Country : US
Telephone Number : 651-748-5019
Fax Number : 651-773-7591
Provider Business Practice Location Address
First Line : 2115 COUNTY ROAD D E
Second Line : SUITE B
City : MAPLEWOOD
State : MN
Zip : 55109-5353
Country : US
Telephone Number : 651-748-5019
Fax Number : 651-773-7591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 07/09/2007

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Practice Fax: 651-773-7591

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