=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346670254
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM URBINE MED, LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2013
-----------------------------------------------------
Last Update Date | 11/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1422 MAIN ST
-----------------------------------------------------
City | HELLERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18055-1351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-838-2880
-----------------------------------------------------
Fax | 610-838-2781
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1422 MAIN ST
-----------------------------------------------------
City | HELLERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18055-1351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-838-2880
-----------------------------------------------------
Fax | 610-838-2781
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | MF000205
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MF000205
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------