Healthcare Provider Details

I. General information

NPI: 1184189144
Provider Name (Legal Business Name): MARIAH SKY HUTCHINSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 UNIVERSITY AVE W STE 202
SAINT PAUL MN
55114-1769
US

IV. Provider business mailing address

1219 W 24TH ST APT 5
MINNEAPOLIS MN
55405-2614
US

V. Phone/Fax

Practice location:
  • Phone: 612-894-5124
  • Fax:
Mailing address:
  • Phone: 715-579-4825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1662
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: