Provider Demographics
NPI:1427656891
Name:BRIXIUS, MARY HELEN (LICSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HELEN
Last Name:BRIXIUS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1784
Mailing Address - Country:US
Mailing Address - Phone:612-227-7371
Mailing Address - Fax:
Practice Address - Street 1:755 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1784
Practice Address - Country:US
Practice Address - Phone:612-227-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN155231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical