Provider Demographics
NPI:1194411090
Name:CYCENAS, JOEL EDWARD (M DIV)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:EDWARD
Last Name:CYCENAS
Suffix:
Gender:M
Credentials:M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3634 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4471
Mailing Address - Country:US
Mailing Address - Phone:763-516-8068
Mailing Address - Fax:
Practice Address - Street 1:3634 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-4471
Practice Address - Country:US
Practice Address - Phone:763-516-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral