Provider Demographics
NPI:1396004586
Name:BOIKE, MICHAEL J (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:BOIKE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 ABERDEEN ST NE
Mailing Address - Street 2:STE 100
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4810
Mailing Address - Country:US
Mailing Address - Phone:763-270-0054
Mailing Address - Fax:763-208-6371
Practice Address - Street 1:11800 ABERDEEN ST NE
Practice Address - Street 2:STE 100
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4810
Practice Address - Country:US
Practice Address - Phone:763-270-0054
Practice Address - Fax:763-208-6371
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist