Provider Demographics
NPI:1306052899
Name:HUMAGINE, INC.
Entity type:Organization
Organization Name:HUMAGINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:763-519-1686
Mailing Address - Street 1:6349 RANCHVIEW LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3925
Mailing Address - Country:US
Mailing Address - Phone:763-519-1686
Mailing Address - Fax:763-519-0684
Practice Address - Street 1:7382 KIRKWOOD CT
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5270
Practice Address - Country:US
Practice Address - Phone:763-528-3450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty