Provider Demographics
NPI:1306039854
Name:MAUS, MICHAEL EARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EARL
Last Name:MAUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2521 HUMBOLDT AVE S APT 108
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-3528
Mailing Address - Country:US
Mailing Address - Phone:612-377-6113
Mailing Address - Fax:
Practice Address - Street 1:415 BLAKE RD N
Practice Address - Street 2:SUITE 240
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8108
Practice Address - Country:US
Practice Address - Phone:952-814-0207
Practice Address - Fax:952-938-8838
Is Sole Proprietor?:No
Enumeration Date:2007-08-18
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0574103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1306039854OtherBLUECROSS BLUESHIELD OF MINNESOTA
MN1306039854OtherHEALTHPARTNERS
MN1306039854Medicaid