MEDICARE: EMILY KRANTZ 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	CC02066	MN

General Provider Information

NPI Number	:	1740833326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY KRANTZ LPCC

Provider Business Mailing Address
First Line	:	20 LAKE ST N STE 302
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2512
Country	:	US
Telephone Number	:	651-900-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 LAKE ST N STE 302
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2512
Country	:	US
Telephone Number	:	651-900-5879
Fax Number	:

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

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	12/09/2020

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