MEDICARE: MAJI THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1619621950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAJI THERAPY PLLC

Provider Business Mailing Address
First Line	:	1730 NEW BRIGHTON BLVD STE 104-315
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1248
Country	:	US
Telephone Number	:	734-957-6632
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 NEW BRIGHTON BLVD STE 104-315
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1248
Country	:	US
Telephone Number	:	734-957-6632
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	MRS. NADIA L SULLIVAN-MARSHALL
Credential	:	LICSW
Telephone Number	:	734-957-6632

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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