Provider Demographics
NPI:1043330335
Name:DMA CONSULTING LLC
Entity Type:Organization
Organization Name:DMA CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:651-257-4406
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-0536
Mailing Address - Country:US
Mailing Address - Phone:651-257-4406
Mailing Address - Fax:651-257-4406
Practice Address - Street 1:24799 FOREST BLVD
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-7215
Practice Address - Country:US
Practice Address - Phone:651-257-4406
Practice Address - Fax:651-257-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9630OtherBCBS
MN172491OtherUCARE
MN9629OtherBCBS
MN172491OtherBHP
MN6274983OtherMEDICA