Provider Demographics
NPI:1437230570
Name:SAMMON, BRIAN PATRICK (LMFT LADC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PATRICK
Last Name:SAMMON
Suffix:
Gender:M
Credentials:LMFT LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 EAST HWY 13
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-564-3000
Mailing Address - Fax:952-564-3031
Practice Address - Street 1:501 EAST HWY 13
Practice Address - Street 2:SUITE 108
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-564-3000
Practice Address - Fax:952-564-3031
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300060101YA0400X
MN945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6267693OtherUBH
151715OtherUCARE
MN9D633SAOtherBCBS
MN464733000OtherMAGELLAN
MN876497200Medicaid
MN1023425OtherPREFERRED ONE/BHP
MNHP34494OtherHP/CIGNA
MN411910086OtherCORPHEALTH