MEDICARE: HERBERT HERMAN LAUBE PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0460	MN

General Provider Information

NPI Number	:	1659583318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERBERT HERMAN LAUBE PH.D

Provider Business Mailing Address
First Line	:	1660 S. HIGHWAY L00 PARKDALE PLAZA
Second Line	:	SUITE # L42
City	:	ST. LOUIS PARK
State	:	MN
Zip	:	55416-3823
Country	:	US
Telephone Number	:	952-544-5719
Fax Number	:	952-544-5719

Provider Business Practice Location Address
First Line	:	L660 SOUTH HIGHWAY L00
Second Line	:	SUITE L42
City	:	ST. LOUIS PARK
State	:	MN
Zip	:	55416-3823
Country	:	US
Telephone Number	:	952-544-5719
Fax Number	:	952-544-5719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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