Provider Demographics
NPI:1750035184
Name:LORD, MARIAH (LMFT)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 GRAND AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2630
Mailing Address - Country:US
Mailing Address - Phone:920-296-2955
Mailing Address - Fax:
Practice Address - Street 1:2388 UNIVERSITY AVE W # 202
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1769
Practice Address - Country:US
Practice Address - Phone:612-351-2260
Practice Address - Fax:651-300-2702
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
171M00000X, 390200000X
MN4578106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program