Provider Demographics
NPI:1750597605
Name:DANESHPOUR, MANIJEH (PHD)
Entity type:Individual
Prefix:
First Name:MANIJEH
Middle Name:
Last Name:DANESHPOUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7382 KIRKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5270
Mailing Address - Country:US
Mailing Address - Phone:763-391-2209
Mailing Address - Fax:
Practice Address - Street 1:7382 KIRKWOOD CT
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5270
Practice Address - Country:US
Practice Address - Phone:763-391-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT #865106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6141657OtherMEDICA
MN111589OtherUCARE
MN3051108OtherHEALTH PARTNERS
MN64G53DAOtherBLUE CROSS BLUE SHIELD MN
MN990991013908OtherPREFERRED ONE