Provider Demographics
NPI:1891895660
Name:ADAMS, GENEVA H (LP)
Entity Type:Individual
Prefix:MS
First Name:GENEVA
Middle Name:H
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:M
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LP
Mailing Address - Street 1:3951 GIRARD AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2017
Mailing Address - Country:US
Mailing Address - Phone:612-716-1721
Mailing Address - Fax:763-784-3647
Practice Address - Street 1:425 COON RAPIDS BLVD NW
Practice Address - Street 2:NSCC
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5649
Practice Address - Country:US
Practice Address - Phone:763-784-3008
Practice Address - Fax:763-784-3647
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2201103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN124051OtherUCARE
MN51B75ADOtherBLUE CROSS
MN62-50641OtherMEDICA