Healthcare Provider Details

I. General information

NPI: 1124981667
Provider Name (Legal Business Name): SYRIC BARBER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MARTY DR STE 2
BUFFALO MN
55313-9345
US

IV. Provider business mailing address

10540 64TH LN NE
ALBERTVILLE MN
55301-3531
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-5420
  • Fax:
Mailing address:
  • Phone: 612-990-5053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL763651
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5330
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: