Healthcare Provider Details

I. General information

NPI: 1922911718
Provider Name (Legal Business Name): EXPANSIVE RELATIONS THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E 45TH ST
MINNEAPOLIS MN
55419-5026
US

IV. Provider business mailing address

7201 METRO BLVD STE 550
EDINA MN
55439-1353
US

V. Phone/Fax

Practice location:
  • Phone: 507-366-8963
  • Fax:
Mailing address:
  • Phone: 507-366-8963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MAYA SEVERSON-MCCORMICK
Title or Position: OWNER, THERAPIST
Credential: LMFT
Phone: 320-491-8773