Healthcare Provider Details

I. General information

NPI: 1346670254
Provider Name (Legal Business Name): WILLIAM URBINE MED, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 MAIN ST
HELLERTOWN PA
18055-1351
US

IV. Provider business mailing address

1422 MAIN ST
HELLERTOWN PA
18055-1351
US

V. Phone/Fax

Practice location:
  • Phone: 610-838-2880
  • Fax: 610-838-2781
Mailing address:
  • Phone: 610-838-2880
  • Fax: 610-838-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMF000205
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000205
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: