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NPI Code Detail

MEDICARE: JENNIFER LYNN URBACH MA, LPCC

MEDICARE: JENNIFER LYNN URBACH MA, 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
1101YP2500XProfessional Counselor1702MN

General Provider Information

NPI Number : 1417464033
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN URBACH MA, LPCC
Provider Business Mailing Address
First Line : 73 E GOLDEN LAKE RD
Second Line :
City : CIRCLE PINES
State : MN
Zip : 55014-1702
Country : US
Telephone Number : 651-317-9081
Fax Number : 763-703-3725
Provider Business Practice Location Address
First Line : 4255 PHEASANT RIDGE DR NE STE 412
Second Line :
City : BLAINE
State : MN
Zip : 55449-5066
Country : US
Telephone Number : 763-703-3754
Fax Number : 763-703-3725
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2018
Last Update Date : 04/22/2022

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