Individual provider Active NPI

Mariya D. Mirzoyan, PSYD, LP.

  • Counseling Psychologist
  • Edina, MN
National Provider Identifier
1790507937
Registry record updated May 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
LP7118 Issued in MN
Practice address
7201 Metro Blvd Ste 550
Edina, MN 55439-1353
Phone
(612) 310-1503
NPI assigned
Oct 29, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP7118 MN
Counseling PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC1900X LP7118 MN Primary

Addresses

Primary practice location

7201 Metro Blvd Ste 550
Edina, MN 55439-1353

Mailing address

4120 Parklawn Ave Apt 227
Edina, MN 55435-4691
Phone (612) 310-1503

Other practice location 1

200 4th Ave W
Shakopee, MN 55379-1220
Phone (952) 496-8570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250611001344 MN Practitioner - Psychologist Billing Independently 4880104538

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Double Healix Consulting & Psychological Services Counseling CurrentSince Nov 3, 2024 Accepting new patients
Stone Arch Psychology and Health Services Clinical Current Accepting new patients
County of Scott CurrentSince Mar 8, 2025 Accepting new patients
County of Scott Single Specialty CurrentSince Mar 8, 2025 Accepting new patients

Locations

7201 Metro Blvd
Ste 550
Minneapolis, MN 55439
Phone (612) 208-6807

200 4th Ave W
Shakopee, MN 55379
Phone (952) 496-8481

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778544000000",
    "number": "1790507937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 PARKLAWN AVE APT 227",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354691",
            "telephone_number": "612-310-1503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 METRO BLVD STE 550",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554391353",
            "telephone_number": "612-310-1503"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 4th Ave W",
            "address_purpose": "LOCATION",
            "city": "Shakopee",
            "state": "MN",
            "postal_code": "553791220",
            "country_code": "US",
            "telephone_number": "952-496-8570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRZOYAN",
        "first_name": "MARIYA",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-29",
        "last_updated": "2026-05-12",
        "certification_date": "2026-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP7118",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP7118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.