Provider Demographics
NPI:1235446360
Name:LEMKE EBENHOCH, TARA (LMFT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LEMKE EBENHOCH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:LEMKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:6043 HUDSON RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1018
Mailing Address - Country:US
Mailing Address - Phone:651-200-6092
Mailing Address - Fax:
Practice Address - Street 1:1678 SELBY AVE OFC
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:763-228-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist