MEDICARE: AYODELE REGINA DOUGLAS MENTAL HEALTH PRACTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548890379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYODELE REGINA DOUGLAS MENTAL HEALTH PRACTI

Provider Business Mailing Address
First Line	:	2800 FREEWAY BLVD STE 204
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	763-412-1996
Fax Number	:	763-292-5653

Provider Business Practice Location Address
First Line	:	2800 FREEWAY BLVD STE 204
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	763-412-1996
Fax Number	:	763-292-5653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2020
Last Update Date	:	01/21/2020

Similar Medicare Providers

1063654598 — JUNEAU RONNYE HILL LICSW
Practice Location Address:

2800 FREEWAY BLVD STE 118
MINNEAPOLIS, MN
55430-1751

Practice Phone: 612-986-3836
Practice Fax: 757-937-0964

1225562333 — ALEXANDRIA GRIM LPCC
Practice Location Address:

2800 FREEWAY BLVD STE 113
MINNEAPOLIS, MN
55430-1751

Practice Phone: 314-295-9103
Practice Fax:

1568085546 — BREAKING FREE COUNSELING AND CONSULTING SERVICES
Practice Location Address:

2800 FREEWAY BLVD STE 113
MINNEAPOLIS, MN
55430-1751

Practice Phone: 612-430-9298
Practice Fax:

1154947901 — BRANDON CHRISTOPHER BADER
Practice Location Address:

2800 FREEWAY BLVD STE 204
MINNEAPOLIS, MN
55430-1751

Practice Phone: 763-412-1996
Practice Fax: 763-292-5653

1801409396 — ANTOINETTE M GOODMAN
Practice Location Address:

2800 FREEWAY BLVD STE 105
MINNEAPOLIS, MN
55430-1751

Practice Phone: 612-430-9298
Practice Fax: 833-736-7476

1245827690 — MISS MARYLOVELINE CHINWEDU EJIOFOR
Practice Location Address:

2800 FREEWAY BLVD STE 204
MINNEAPOLIS, MN
55430-1751

Practice Phone: 763-412-1996
Practice Fax: 763-292-5653

Directions to “ AYODELE REGINA DOUGLAS MENTAL HEALTH PRACTI” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.