NPI 1003486564

Mystic Makepeace

Practitioner Behavior Technician Minneapolis, MN

Practice location

Address: 3333 University Ave SE, Minneapolis, MN 55414-3325
Phone: (612) 767-7222
Mailing address: 1564 Randolph Ave APT 202, Saint Paul, MN 55105-2541

Registered specialties

Behavior Technician Primary

Behavioral Health & Social Service Providers Taxonomy 106S00000X

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Registry record

NPI: 1003486564
Entity type: Individual
Sex (as registered): Female
NPI issued: 28 Jun 2021
Record last updated: 28 Jun 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.