MEDICARE: MAVIS RICE MA LP

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	103TC0700X	Clinical Psychologist	4004	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62-50536	OTHER	MN	MEDICA/UBH
2	HP50743	OTHER	FM	HEALTHPARTNERS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	39Q41BU	OTHER	MN	BCBS GROUP
5	83G85K1	OTHER	MN	BCBS INDIVIDUAL
6	167373	OTHER	MN	U CARE
7	30433-01	OTHER	MN	PREFERREDONE (BPH)

General Provider Information

NPI Number	:	1790869121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAVIS RICE MA LP

Provider Business Mailing Address
First Line	:	6542 REGENCY LANE
Second Line	:	SUITE 206
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344
Country	:	US
Telephone Number	:	952-736-7136
Fax Number	:	952-903-9257

Provider Business Practice Location Address
First Line	:	6542 REGENCY LN
Second Line	:	SUITE 206
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7847
Country	:	US
Telephone Number	:	952-736-7136
Fax Number	:	952-903-9257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	02/08/2026

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Directions to “ MAVIS RICE MA LP” Practice Location

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