Provider Demographics
NPI:1083839807
Name:AVENDANO, MARY JO ISABEL (LMFT)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:ISABEL
Last Name:AVENDANO
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 1:6401 LYNDALE AVE S
Mailing Address - Street 2:SUITE 315
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1405
Mailing Address - Country:US
Mailing Address - Phone:612-558-2233
Mailing Address - Fax:
Practice Address - Street 1:6401 LYNDALE AVE S
Practice Address - Street 2:SUITE 315
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-1405
Practice Address - Country:US
Practice Address - Phone:612-558-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist