Healthcare Provider Details

I. General information

NPI: 1396678991
Provider Name (Legal Business Name): MS. MOLLY PAVEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 METRO BLVD STE 505
EDINA MN
55439-3018
US

IV. Provider business mailing address

4327 SEAN CT
EAGAN MN
55123-3994
US

V. Phone/Fax

Practice location:
  • Phone: 651-271-1665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: