MEDICARE: DR. DAMIR S. UTRZAN PH.D., LMFT, DAAETS

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	106H00000X	Marriage & Family Therapist	2039-124	WI
2	106H00000X	Marriage & Family Therapist	3322	MN

General Provider Information

NPI Number	:	1548708464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMIR S. UTRZAN PH.D., LMFT, DAAETS

Provider Business Mailing Address
First Line	:	971 SIBLEY MEMORIAL HWY STE NO250
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55118-2324
Country	:	US
Telephone Number	:	612-900-7021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 NORTHLAND DR STE 270
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1373
Country	:	US
Telephone Number	:	612-900-7021
Fax Number	:

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

Provider Enumeration Date	:	02/11/2017
Last Update Date	:	09/09/2024

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