Provider Demographics
NPI:1265905103
Name:MAZIARKA, TATIANA (LPCC, LADC)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:MAZIARKA
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 SAPPHIRE PT
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-8804
Mailing Address - Country:US
Mailing Address - Phone:612-644-0414
Mailing Address - Fax:
Practice Address - Street 1:1858 SAPPHIRE PT
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-8804
Practice Address - Country:US
Practice Address - Phone:612-209-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305115101YA0400X
MNCC01940101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)