Healthcare Provider Details

I. General information

NPI: 1750035184
Provider Name (Legal Business Name): MARIAH LORD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

391 GRAND AVE APT 307
SAINT PAUL MN
55102-2630
US

V. Phone/Fax

Practice location:
  • Phone: 612-351-2260
  • Fax: 651-300-2702
Mailing address:
  • Phone: 920-296-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4578
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: