Provider Demographics
NPI:1063930238
Name:HIGGINS, SEAN THOMAS (LADC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-7306
Mailing Address - Country:US
Mailing Address - Phone:218-855-8767
Mailing Address - Fax:651-431-7437
Practice Address - Street 1:11615 STATE AVE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-7306
Practice Address - Country:US
Practice Address - Phone:218-855-8767
Practice Address - Fax:651-431-7437
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116734183500000X
MN5148101YM0800X
MN304904101YA0400X
SD4890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No183500000XPharmacy Service ProvidersPharmacist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5148OtherLPCC
MN304904OtherLADC