Healthcare Provider Details

I. General information

NPI: 1407314933
Provider Name (Legal Business Name): MEREDITH BARKER YARBROUGH MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEREDITH LYNNE BARKER

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 COUNTY ROAD 25
MINNEAPOLIS MN
55416-2629
US

IV. Provider business mailing address

4240 PARK GLEN RD
ST LOUIS PARK MN
55416-5427
US

V. Phone/Fax

Practice location:
  • Phone: 612-925-6033
  • Fax: 612-925-8496
Mailing address:
  • Phone: 612-925-6033
  • Fax: 612-925-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2060
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2060
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: