Provider Demographics
NPI:1134380058
Name:BEISWENGER, DONALD I (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:I
Last Name:BEISWENGER
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:MR
Other - First Name:DONALD
Other - Middle Name:I
Other - Last Name:BEISWENGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11010 PRAIRE LAKES DRIVE, SUITE 250
Practice Address - Street 2:PRAIRIE LAKES CORPORATE CENTER II
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344
Practice Address - Country:US
Practice Address - Phone:952-746-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN176106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist