Provider Demographics
NPI:1619645124
Name:MCCABE, VICTORY A
Entity Type:Individual
Prefix:
First Name:VICTORY
Middle Name:A
Last Name:MCCABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2134
Mailing Address - Country:US
Mailing Address - Phone:417-293-9404
Mailing Address - Fax:
Practice Address - Street 1:5780 LINCOLN DR STE 250
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-1667
Practice Address - Country:US
Practice Address - Phone:763-400-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist