Provider Demographics
NPI:1477371490
Name:NOVOTNY, ALYCIA (MA)
Entity type:Individual
Prefix:
First Name:ALYCIA
Middle Name:
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 COON RAPIDS BLVD NW STE 208
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5860
Mailing Address - Country:US
Mailing Address - Phone:612-440-1899
Mailing Address - Fax:612-500-4499
Practice Address - Street 1:199 COON RAPIDS BLVD NW STE 208
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5860
Practice Address - Country:US
Practice Address - Phone:612-440-1899
Practice Address - Fax:612-500-4499
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist