Active NPI
Mary Elizabeth Devorak, LMFT
- Marriage & Family Therapist
- Minneapolis, MN
National Provider Identifier
1124408307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 2883
- Practice address
- 726 2ND St NE
Minneapolis, MN 55413-1662 - Phone
- (612) 465-0105
- NPI assigned
- Jun 3, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 2883 | MN | Primary |
Addresses
Primary practice location
726 2ND St NE
Minneapolis, MN 55413-1662
Mailing address
726 2ND St NE
Minneapolis, MN 55413-1662
Phone (612) 465-0105
Other names 1
- Mary Elizabeth Thoreson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2883 | MN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523491200000",
"number": "1124408307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "726 2ND ST NE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554131662",
"telephone_number": "612-465-0105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "726 2ND ST NE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554131662",
"telephone_number": "612-465-0105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVORAK",
"first_name": "MARY",
"middle_name": "ELIZABETH",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-03",
"last_updated": "2018-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "2883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "THORESON",
"middle_name": "ELIZABETH",
"credential": "LMFT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.