Provider Demographics
NPI:1700648094
Name:ABDELLA, MAYA
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:ABDELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 WASHINGTON DR STE 206
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1354
Mailing Address - Country:US
Mailing Address - Phone:763-657-6839
Mailing Address - Fax:
Practice Address - Street 1:3470 WASHINGTON DR STE 206
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1354
Practice Address - Country:US
Practice Address - Phone:651-505-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health