Provider Demographics
NPI:1730533399
Name:BEAN, JAMES II (LICSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BEAN
Suffix:II
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13200 E MANOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2092
Mailing Address - Country:US
Mailing Address - Phone:952-686-4735
Mailing Address - Fax:
Practice Address - Street 1:13200 E MANOR BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2092
Practice Address - Country:US
Practice Address - Phone:952-686-4735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN231091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical