Provider Demographics
NPI:1235985037
Name:THAO, MAI NTSHIAB (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:NTSHIAB
Last Name:THAO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3189 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5319
Mailing Address - Country:US
Mailing Address - Phone:651-350-9015
Mailing Address - Fax:
Practice Address - Street 1:6776 LAKE DR STE 170
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1201
Practice Address - Country:US
Practice Address - Phone:763-291-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health