MEDICARE: ANA BOLENA MACIAS

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	101YP2500X	Professional Counselor	4921	MN

General Provider Information

NPI Number	:	1982556189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA BOLENA MACIAS

Provider Business Mailing Address
First Line	:	28 E 125TH ST
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1687
Country	:	US
Telephone Number	:	952-220-3425
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 E 125TH ST
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1687
Country	:	US
Telephone Number	:	952-220-3425
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ ANA BOLENA MACIAS ” Practice Location

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