MEDICARE: SYRIC BARBER LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	L763651	MN
2	101YP2500X	Professional Counselor	5330	MN

General Provider Information

NPI Number	:	1124981667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYRIC BARBER LPCC

Provider Business Mailing Address
First Line	:	10540 64TH LN NE
Second Line	:
City	:	ALBERTVILLE
State	:	MN
Zip	:	55301-3531
Country	:	US
Telephone Number	:	612-990-5053
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 MARTY DR STE 2
Second Line	:
City	:	BUFFALO
State	:	MN
Zip	:	55313-9345
Country	:	US
Telephone Number	:	763-682-5420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ SYRIC BARBER LPCC” Practice Location

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