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NPI Code Detail

MEDICARE: MARY-NYAKOUN K KHAWAY MA

MEDICARE: MARY-NYAKOUN K KHAWAY MA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1659919355
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY-NYAKOUN K KHAWAY MA
Provider Business Mailing Address
First Line : 6120 EARLE BROWN DR STE 100
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55430-4100
Country : US
Telephone Number : 763-277-1020
Fax Number : 763-537-7162
Provider Business Practice Location Address
First Line : 8590 EDINBURGH CENTER DR
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-3723
Country : US
Telephone Number : 763-425-5959
Fax Number : 763-425-5929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2019
Last Update Date : 02/23/2022

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