Provider Demographics
NPI:1902277783
Name:THAO, MAI NHIA (LMFT)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:NHIA
Last Name:THAO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 E RIVER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1024
Mailing Address - Country:US
Mailing Address - Phone:763-432-3926
Mailing Address - Fax:763-951-2132
Practice Address - Street 1:5301 E RIVER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421-1024
Practice Address - Country:US
Practice Address - Phone:763-432-3926
Practice Address - Fax:763-951-2132
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist