Provider Demographics
NPI:1962689554
Name:PAVLIK, EMILY (LADC, LMFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PAVLIK
Suffix:
Gender:F
Credentials:LADC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 SLATER RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:651-246-8895
Mailing Address - Fax:651-344-7655
Practice Address - Street 1:4660 SLATER RD
Practice Address - Street 2:SUITE 225
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122
Practice Address - Country:US
Practice Address - Phone:651-246-8895
Practice Address - Fax:651-344-7655
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301842101YA0400X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2221OtherLMFT
MN301842OtherLADC