Healthcare Provider Details

I. General information

NPI: 1003242249
Provider Name (Legal Business Name): MELISSA LEA URBANEK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W STE 435 S
SAINT PAUL MN
55114-1052
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W STE 435 S
SAINT PAUL MN
55114-1052
US

V. Phone/Fax

Practice location:
  • Phone: 651-647-1900
  • Fax: 651-647-1861
Mailing address:
  • Phone: 651-647-1900
  • Fax: 651-647-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2147
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: