Healthcare Provider Details

I. General information

NPI: 1447453360
Provider Name (Legal Business Name): JENNIFER URENA-TAVERAS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HIGHWAY 7
HOPKINS MN
55305-4723
US

IV. Provider business mailing address

8920 18TH AVE S
BLOOMINGTON MN
55425-2014
US

V. Phone/Fax

Practice location:
  • Phone: 952-938-7040
  • Fax: 952-938-4708
Mailing address:
  • Phone: 612-237-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1391
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: