Healthcare Provider Details

I. General information

NPI: 1790507937
Provider Name (Legal Business Name): MARIYA D. MIRZOYAN PSYD, LP.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 METRO BLVD STE 550
EDINA MN
55439-1353
US

IV. Provider business mailing address

4120 PARKLAWN AVE APT 227
EDINA MN
55435-4691
US

V. Phone/Fax

Practice location:
  • Phone: 612-310-1503
  • Fax:
Mailing address:
  • Phone: 612-310-1503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP7118
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP7118
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: