Provider Demographics
NPI:1639981343
Name:MYNA EARLY INTERVENTION LLC
Entity type:Organization
Organization Name:MYNA EARLY INTERVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZING OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOERFLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-347-1782
Mailing Address - Street 1:4575 23RD AVE S STE 400
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8783
Mailing Address - Country:US
Mailing Address - Phone:701-347-1782
Mailing Address - Fax:701-404-8274
Practice Address - Street 1:4575 23RD AVE S STE 400
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8783
Practice Address - Country:US
Practice Address - Phone:701-347-1782
Practice Address - Fax:701-404-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency