Provider Demographics
NPI:1366441685
Name:ARIKIAN, NANCY J (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:ARIKIAN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S. 1ST ST.
Mailing Address - Street 2:#583294
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55458-3829
Mailing Address - Country:US
Mailing Address - Phone:612-353-5414
Mailing Address - Fax:
Practice Address - Street 1:1409 WILLOW ST STE 416
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2269
Practice Address - Country:US
Practice Address - Phone:612-353-5414
Practice Address - Fax:612-353-5415
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4396103TC1900X
MNLP4396103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN088488000Medicaid
MN680001618Medicare PIN