Healthcare Provider Details

I. General information

NPI: 1174719280
Provider Name (Legal Business Name): MARI ROBYN TANKENOFF LMHC, LPCC, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W LAKE ST STE 350
MINNEAPOLIS MN
55408-2952
US

IV. Provider business mailing address

621 W LAKE ST STE 350
MINNEAPOLIS MN
55408-2952
US

V. Phone/Fax

Practice location:
  • Phone: 612-979-2276
  • Fax: 651-925-0427
Mailing address:
  • Phone: 505-204-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC0112771
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP3024
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC009443
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC255
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC15619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: