Provider Demographics
NPI:1326207713
Name:PLAYER, ANTWAN
Entity Type:Individual
Prefix:
First Name:ANTWAN
Middle Name:
Last Name:PLAYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 AMERICAN BLVD E STE 5A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1152
Mailing Address - Country:US
Mailing Address - Phone:763-732-9476
Mailing Address - Fax:
Practice Address - Street 1:1325 AMERICAN BLVD E STE 5A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1152
Practice Address - Country:US
Practice Address - Phone:763-732-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02361101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor