Healthcare Provider Details

I. General information

NPI: 1780439216
Provider Name (Legal Business Name): MARIA MYLONAKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SELBY AVE STE S
SAINT PAUL MN
55102-4520
US

IV. Provider business mailing address

400 SELBY AVE STE S
SAINT PAUL MN
55102-4520
US

V. Phone/Fax

Practice location:
  • Phone: 651-571-2865
  • Fax: 651-369-5356
Mailing address:
  • Phone: 651-571-2865
  • Fax: 651-369-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5788
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: