Basic Information
| Provider Information | |||||||||
| NPI: | 1831385491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URAN | ||||||||
| FirstName: | JUSTINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 W LAKE ST | ||||||||
| Address2: | STE 350 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554082952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6129792276 | ||||||||
| FaxNumber: | 6519250427 | ||||||||
| Practice Location | |||||||||
| Address1: | 5745 NEWTON AVE S | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127038003 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 18072 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.