Healthcare Provider Details

I. General information

NPI: 1609939198
Provider Name (Legal Business Name): PARI BEYZAVI PH.D, L.M.F.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 LANCASTER LN N STE 102
PLYMOUTH MN
55441-1702
US

IV. Provider business mailing address

4205 LANCASTER LN N STE 102
PLYMOUTH MN
55441-1702
US

V. Phone/Fax

Practice location:
  • Phone: 763-551-1850
  • Fax: 763-551-1851
Mailing address:
  • Phone: 763-551-1850
  • Fax: 763-551-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number881
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: