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General NPI Number Information
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NPI Number | 1366687451
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Entity Type | Individual
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Provider Name | MIRIAM ZACHARY MA, LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 521 TANGLEWOOD DR
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City | SHOREVIEW
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State | MN
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Zip | 55126-2016
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Country | US
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Telephone | 612-598-0184
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Fax |
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Provider Business Mailing Address
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Address Line | 49 S DEEP LAKE RD
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City | NORTH OAKS
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State | MN
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Zip | 55127-6312
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Country | US
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Telephone | 612-598-0184
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1844
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License Number State | MN
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