Provider Demographics
NPI:1720084502
Name:DUBOIS, DAVID ALLAN (MASTERS OF ARTS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLAN
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:MASTERS OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2412
Mailing Address - Country:US
Mailing Address - Phone:612-296-9444
Mailing Address - Fax:
Practice Address - Street 1:3332 21ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2412
Practice Address - Country:US
Practice Address - Phone:612-296-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-25
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MNLP2840103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0004399432OtherAETNA INS. CO.
MN2347539-00OtherMINNESOTA CARE
MN123475OtherBEHAVIORALHEALTHCAREPROVI
MN030822002OtherMETROPLIITANHEALTHPLAN
MN57332-DUOtherBLUECROSS/BLUESHIELD MN
MN6276558OtherUNITEDBEHAVIORALHEALTH
MN234753900Medicaid