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General NPI Number Information
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NPI Number | 1124716006
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Entity Type | Individual
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Provider Name | ALEJANDRO MALDONADO RODRIGUEZ MA, LMFT, CHI
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Gender | Male
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 4306 BRYANT AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55409-1709
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Country | US
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Telephone | 651-492-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 4732 17TH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-3614
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Country | US
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Telephone | 651-492-5544
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Fax | 612-722-5121
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4446
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License Number State | MN
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