Provider Demographics
NPI:1417188376
Name:BETTE MAGYAR JOHNSON CONSULTING, INC.
Entity Type:Organization
Organization Name:BETTE MAGYAR JOHNSON CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:MAGYAR
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:952-404-2610
Mailing Address - Street 1:205 BARRY AVE S
Mailing Address - Street 2:#321
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1655
Mailing Address - Country:US
Mailing Address - Phone:952-404-2610
Mailing Address - Fax:
Practice Address - Street 1:430 OAK STREET
Practice Address - Street 2:SUITE 403
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403
Practice Address - Country:US
Practice Address - Phone:612-871-8684
Practice Address - Fax:612-871-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN525850200OtherMEDICAL ASSISTANCE
MN62093JOOtherBCBS
MN113885OtherUCARE
MN6145828OtherMEDICA-UBH
MN680000377Medicare PIN