MEDICARE: LAURA HOLMBERG 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	101YP2500X	Professional Counselor	CC02692	MN

General Provider Information

NPI Number	:	1639898158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HOLMBERG LPCC

Provider Business Mailing Address
First Line	:	16881 SADDLEWOOD TRL
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-2676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 HARBOR LN N STE 1600
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-5142
Country	:	US
Telephone Number	:	763-230-2917
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	01/21/2026

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