Healthcare Provider Details

I. General information

NPI: 1124935739
Provider Name (Legal Business Name): MACY MICHELLE VARGAS MA, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 ARIEL ST N
SAINT PAUL MN
55109-2248
US

IV. Provider business mailing address

2365 ARIEL ST N
SAINT PAUL MN
55109-2248
US

V. Phone/Fax

Practice location:
  • Phone: 651-276-6083
  • Fax:
Mailing address:
  • Phone: 651-276-6083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: