Provider Demographics
NPI:1902194608
Name:DEEP RIVER INC.
Entity Type:Organization
Organization Name:DEEP RIVER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:612-729-9869
Mailing Address - Street 1:2432 SEABURY AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1454
Mailing Address - Country:US
Mailing Address - Phone:612-729-9869
Mailing Address - Fax:612-729-0201
Practice Address - Street 1:2432 SEABURY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1454
Practice Address - Country:US
Practice Address - Phone:612-729-9869
Practice Address - Fax:612-729-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health