Provider Demographics
NPI:1275831984
Name:MORIN, MATANA LEVIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATANA
Middle Name:LEVIA
Last Name:MORIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141139
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-6139
Mailing Address - Country:US
Mailing Address - Phone:651-334-9561
Mailing Address - Fax:
Practice Address - Street 1:7525 4TH AVE
Practice Address - Street 2:SOTP
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1006
Practice Address - Country:US
Practice Address - Phone:651-717-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical