Active NPI
Mariya D. Mirzoyan, PSYD, LP.
- Counseling Psychologist
- Edina, MN
National Provider Identifier
1790507937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- LP7118
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP7118 | MN | |
| Counseling Psychologist | 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250611001344 | MN | Practitioner - Psychologist Billing Independently | 4880104538 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Double Healix Consulting & Psychological Services | Counseling | Current | Accepting new patients |
| Stone Arch Psychology and Health Services | Clinical | Current | Accepting new patients |
| County of Scott | Current | Accepting new patients | |
| County of Scott | Single Specialty | Current | 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.
-
- Counseling Psychologist
- Edina, MN
- NPI 1073441796
-
- Public Health or Welfare Agency
- Shakopee, MN
- NPI 1821156183
-
dba Scott County Mental Health Center
- Psychologist
- Shakopee, MN
- NPI 1841299443
Single Specialty
-
- Clinical Psychologist
- Minneapolis, MN
- NPI 1124398607
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": []
}
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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.