Provider Demographics
NPI:1265666317
Name:JAN SEARCH MSW LICSW
Entity type:Organization
Organization Name:JAN SEARCH MSW LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-922-2888
Mailing Address - Street 1:6800 FRANCE AVE S
Mailing Address - Street 2:SUITE 560
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2007
Mailing Address - Country:US
Mailing Address - Phone:952-922-2888
Mailing Address - Fax:763-754-6809
Practice Address - Street 1:6800 FRANCE AVE S
Practice Address - Street 2:SUITE 560
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2007
Practice Address - Country:US
Practice Address - Phone:952-922-2888
Practice Address - Fax:763-754-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02586103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty