Provider Demographics
NPI:1174947238
Name:GILES, MAISHA (LICSW, LMFT)
Entity type:Individual
Prefix:
First Name:MAISHA
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:LICSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 ARKWRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3140
Mailing Address - Country:US
Mailing Address - Phone:612-432-5519
Mailing Address - Fax:
Practice Address - Street 1:1547 ARKWRIGHT ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3140
Practice Address - Country:US
Practice Address - Phone:612-432-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2611106H00000X
MN240581041C0700X
MN304694101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical