Provider Demographics
NPI:1003242249
Name:URBANEK, MELISSA LEA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEA
Last Name:URBANEK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:STE 435 S
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1052
Mailing Address - Country:US
Mailing Address - Phone:651-647-1900
Mailing Address - Fax:651-647-1861
Practice Address - Street 1:2550 UNIVERSITY AVE W
Practice Address - Street 2:STE 435 S
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1052
Practice Address - Country:US
Practice Address - Phone:651-647-1900
Practice Address - Fax:651-647-1861
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1003242247Medicaid